Impact of Patient Safety Culture among Nurses on Patient Safety Outcomes

Alaa M. Halimah¹, Ebtisam A. Elhih^{2, 3,} , Nahla A. Alzahrani³, Hawazin Y. Alhawsaw⁴, Ashwaq M. Almashi⁴ and Reem A. Alhassan⁴

¹Risk Management and Patient Safety Department, King Abdullah Medical City, Makkah, Saudi Arabia

²Nursing Research and evidence-based practice Department, King Abdullah Medical City, Makkah, KSA

³PHD Candidate, Department of Critical Care, Faculty of Nursing, Cairo University, Egypt

⁴Quality and Patient Safety Department, King Abdullah Medical City, Makkah, Saudi Arabia

Cite this paper:
Alaa M. Halimah, Ebtisam A. Elhih, Nahla A. Alzahrani, Hawazin Y. Alhawsaw, Ashwaq M. Almashi and Reem A. Alhassan. Impact of Patient Safety Culture among Nurses on Patient Safety Outcomes. American Journal of Nursing Research. 2026; 14(2):47-53. doi: 10.12691/ajnr-14-2-5

Abstract

Background: Improving patient safety requires fostering a culture that encourages healthcare personnel to report errors or near miss-es without fear of punishment. This study aimed to determine the impact of patient safety culture among nurses on patient safety outcomes. Methods: A descriptive cross-sectional research design was conducted in a tertiary care hospital. An anonymous online survey method was used for data collection. It included three sections as follows: section I included nurses’ demographic and work-related characteristics such as gender, marital status, level of education, section II included patient safety culture survey and section III included patient safety outcomes. The categorical variables were represented as frequency and percentage. Continuous variables were represented as mean, and standard deviation. Independent t-test was used to test the differences between two means of continuous variables. ANOVA test was used to test the differences between more than two means of continuous variables. Linear regression was conducted to test relationship between patient safety culture and various outcomes, including adverse events and self-reporting of events. Statistically significant was considered as (p-value ≤ 0.05 &0.01). Results: The positive response rate of patient safety culture dimensions ranged from 19.9% to 81% positive response and the overall PRR was 53.5%. It was also, observed that the majority of nurses (76.2%) rated the patient safety grade as very good/ excellent. Moreover, more than half of nurses (64.8%) never reported any event in their hospital over the past 12 months and 34.4% of the nurses reported from 1 to 5 events over the past 12 months in their hospital. There are no relationships were found among patient safety culture predictors and adverse events of falls, pressure ulcer, CLABSI and CAUTI. While a statistically significant relationship (p = 0.000) was found between patient safety culture and Self-reporting events. Conclusion: The findings indicated a need for enhancement in patient safety; thus, it is advisable to implement interventions aimed at reducing unnecessary patient harm and associated medical costs.

Keywords:
Culture Outcomes Patient Safety

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	World Health Organization (2021). Global Patient Safety Action Plan 2021–2030. Geneva: World Health Organization. .
[2]	World Health Organization. (2024). Global patient safety report 2024: executive summary.
[3]	Mistri, I. U., Badge, A., & Shahu, S. (2023). Enhancing patient safety culture in hospitals. Cureus, 15(12). .
[4]	Moustafa Abdallah Elpasiony, N., & Gouda Ahmed Abd-Elmoghith, N. (2023). The impact of nursing work environment and patient Safety Culture on missed nursing care at Medical and Surgical Departments. International Egyptian Journal of Nursing Sciences and Research, 3(2), 582-599. .
[5]	Phillips, J., Malliaris, A. P., & Bakerjian, D. (2021). Nursing and patient safety. Nursing and Patient Safety. .
[6]	Hessels, A. J., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient safety culture on missed nursing care and adverse patient events. Journal of nursing care quality, 34(4), 287-294. .
[7]	Lu, L., Ko, Y. M., Chen, H. Y., Chueh, J. W., Chen, P. Y., & Cooper, C. L. (2022). Patient safety and staff well-being: organizational culture as a resource. International Journal of Environmental Research and Public Health, 19(6), 3722. .
[8]	Azyabi, A., Karwowski, W., & Davahli, M. R. (2021). Assessing patient safety culture in hospital settings. International journal of environmental research and public health, 18(5), 2466. .
[9]	Hunziker, S., & Blankenagel, M. (2024). Cross-sectional research design. In Research Design in Business and Management: A Practical Guide for Students and Researchers (pp. 187-199). Wiesbaden: Springer Fachmedien Wiesbaden. .
[10]	Pazarcıkcı F, Efe E. (2018). Patient safety in pediatric nursing. SDU Journal of Health Science Institute; 9(2): 169-74. .
[11]	Cho, S. M., & Choi, J. (2018). Patient safety culture associated with patient safety competencies among registered nurses. Journal of Nursing Scholarship, 50(5), 549-557. .
[12]	Westat, R., Sorra, J., Famolaro, T., Dyer, M. N., Khanna, K., & Nelson, D. (2018). Hospital survey on patient safety culture: 2018 user database report. Agency for Healthcare Research and Quality: Rockville, MD, USA. .
[13]	Kakemam, E., Gharaee, H., Rajabi, M. R., Nadernejad, M., Khakdel, Z., Raeissi, P., & Kalhor, R. (2021). Nurses’ perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran. BMC nursing, 20, 1-10. .
[14]	Kumbi, M., Hussen, A., Lette, A., Nuriye, S., & Morka, G. (2020). Patient safety culture and associated factors among health care providers in bale zone hospitals, southeast ethiopia: An institutional based cross-sectional study. Drug, Healthcare and Patient Safety, 1-14.
[15]	Tlili, M. A., Aouicha, W., Sahli, J., Zedini, C., Dhiab, M. B., Chelbi, S., & Mallouli, M. (2021). A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals. Australian Critical Care, 34(4), 363-369. .
[16]	Chegini, Z., Janati, A., Afkhami, M., Behjat, M., & Shariful Islam, S. M. (2020). A comparative study on patient safety culture among emergency nurses in the public and private hospitals of Tabriz, Iran. Nursing open, 7(3), 768-775.
[17]	Ramezani, H., Shahbazi, S., Gilani, N., & Shabanloei, R. (2022). Patient safety culture and its relationship with job satisfaction and adverse events among nurses working in emergency departments: A correlational descriptive study. https:// web.archive.org/ web/20221010210353id_/ https:// assets.researchsquare.com/ files/rs- 2108805/ v1/ 7d665494- 0e2a- 43fa-b665-c91c91f70ed6.pdf?c=1665428025.
[18]	Moosavi, S., Amerzadeh, M., Azmal, M., & Kalhor, R. (2023). The relationship between patient safety culture and adverse events in Iranian hospitals: a survey among 360 nurses. Patient Safety in Surgery, 17(1), 20. .
[19]	Alrasheeday, A. M., Alkubati, S. A., Alqalah, T. A. H., Alrubaiee, G. G., Pasay-An, E., Alshammari, B., & Loutfy, A. (2024). Nurses’ perceptions of patient safety culture and adverse events in Hail City, Saudi Arabia: a cross-sectional approach to improving healthcare safety. BMJ open, 14(9), e084741. .
[20]	Albaalharith, T., & A’aqoulah, A. (2023). Level of patient safety culture awareness among healthcare workers. Journal of Multidisciplinary Healthcare, 321-332.
[21]	Onuigbo, E. P. O. (2024). The Relationship Between Nurse Staffing Ratio of Hospitals and Patient Satisfaction in Emergency Units (Doctoral dissertation, Walden University). .
[22]	Granel-Giménez, N., Palmieri, P. A., Watson-Badia, C. E., Gómez-Ibáñez, R., Leyva-Moral, J. M., & Bernabeu-Tamayo, M. D. (2022). Patient safety culture in European hospitals: A comparative mixed methods study. International journal of environmental research and public health, 19(2), 939. .
[23]	He, H., Chen, X., Tian, L., Long, Y., Li, L., Yang, N., & Tang, S. (2023). Perceived patient safety culture and its associated factors among clinical managers of tertiary hospitals: a cross- sectional survey. BMC nursing, 22(1), 329. .
[24]	Hafezi, A., Babaii, A., Aghaie, B., & Abbasinia, M. (2022). The relationship between patient safety culture and patient safety competency with adverse events: a multicenter cross-sectional study. BMC nursing, 21(1), 292. .
[25]	Han, Y., Kim, J. S., & Seo, Y. (2020). Cross-sectional study on patient safety culture, patient safety competency, and adverse events. Western journal of nursing research, 42(1), 32-40.
[26]	Kaware, M. S., Ibrahim, M. I., Shafei, M. N., Mohd Hairon, S., & Abdullahi, A. U. (2022). Patient safety culture and its associated factors: A situational analysis among nurses in Katsina Public Hospitals, Northwest Nigeria. International journal of environmental research and public health, 19(6), 3305. .
[27]	Segura-García, M. T., Castro Vida, M. Á., García-Martin, M., Álvarez-Ossorio-García de Soria, R., Cortés-Rodríguez, A. E., & López-Rodríguez, M. M. (2023). Patient Safety Culture in a Tertiary Hospital: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 20(3), 2329. .
[28]	Mekonnen, A. B., McLachlan, A. J., Brien, J. A. E., Mekonnen, D., & Abay, Z. (2017). Hospital survey on patient safety culture in Ethiopian public hospitals: a cross-sectional study. Safety in health, 3, 1-11. .
[29]	Abuosi, A. A., Poku, C. A., Attafuah, P. Y., Anaba, E. A., Abor, P. A., Setordji, A., & Nketiah-Amponsah, E. (2022). Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety. Plos one, 17(10), e0275606. .
[30]	Braun, B. I., Chitavi, S. O., Suzuki, H., Soyemi, C. A., & Puig-Asensio, M. (2020). Culture of safety: impact on improvement in infection prevention process and outcomes. Current infectious disease reports, 22(12), 34. .
[31]	Lee, S. E., Scott, L. D., Dahinten, V. S., Vincent, C., Lopez, K. D., & Park, C. G. (2019). Safety culture, patient safety, and quality of care outcomes: a literature review. Western journal of nursing research, 41(2), 279-304.
[32]	Hessels, A. J., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient safety culture on missed nursing care and adverse patient events. Journal of nursing care quality, 34(4), 287-294. https:// journals.lww.com/ jncqjournal/abstract/2019/ 10000/ impact_of_ patient_safety_ culture_on_ missed_ nursing.2.aspx .
[33]	Mansouri, S. F., Mohammadi, T. K., Adib, M., Lili, E. K., & Soodmand, M. (2019). Barriers to nurses reporting errors and adverse events. British Journal of Nursing, 28(11), 690-695.
[34]	Raeissi, P., Reisi, N., & Nasiripour, A. A. (2018). Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses. Journal of patient safety, 14(4), 213-226. .
[35]	Lee, D., Hong, K. S., & Kim, N. Y. (2016). Effects of hospital leadership, organizational systems, and ESWOS on medical error reduction. Service Business, 10, 159-177. https:// link.springer.com/article/10.1007/s11628-014-0262-x.