This article, authored by Jung-hyun Choi and KyoungEun Kim from Namseoul University, Republic of South Korea, was published on November 26, 2024. It explores the critical area of patient safety competency among clinical nurses.
Background: Patient safety is recognized as a critical global issue, aiming to eliminate preventable harm and reduce risks during healthcare. Organizations like the World Health Organization actively campaign for its importance, especially in light of reports such as the 2000 Institute of Medicine (IOM) finding that medical errors were the third-leading cause of death in U.S. hospitals.
Nurses are pivotal in enhancing patient safety due to their continuous presence at patients’ bedsides and their frequent interactions with patients, families, and other healthcare providers. In Korea, nurses constitute the largest segment of the healthcare workforce, underscoring their significant role in ensuring patient safety. Patient safety competency encompasses the necessary knowledge, skills, and attitudes required by medical personnel to prevent errors and improve safety. This includes ethical judgment in complex decision-making, such as preventing, recognizing, reporting, and admitting safety problems, as well as effective communication and education regarding mistakes.
The study identifies key factors influencing patient safety competency, categorizing them into individual aspects like safety education and safety control, and organizational aspects like patient safety culture. A robust patient safety culture is essential, signifying that all professionals prioritize patient safety and share beliefs, values, attitudes, and behaviors aimed at preventing medical errors. Nurses, being optimally positioned to detect errors, find safety culture to be a vital component of their practice. Safety control refers to a nurse’s ability to achieve safe outcomes in tasks, reduce negative safety indicators, and exercise correct judgment in situations that could compromise patient safety.
Purpose of the Study: Given the importance of these factors, the study aimed to thoroughly examine the relationships among safety education, the perception of patient safety culture, safety control, and patient safety competence in clinical nurses. Furthermore, it sought to explore the mediating effect of perceptions of patient safety culture and safety control on the relationship between safety education and patient safety competency. The insights gained are intended to provide crucial evidence for developing targeted interventions to improve nurses’ patient safety competency.
Methodology: This research employed a descriptive correlation study design, utilizing structural equation modeling (SEM) for data analysis. The study involved 165 clinical nurses (10 males, 155 females) conveniently sampled from three hospitals in Seoul and Cheonan, South Korea. Participants were required to have at least one year of clinical experience and voluntarily agree to participate. Data was collected via self-administered questionnaires between October and December 2021. The sample size met the calculated requirement for multiple linear regression analysis.
Key variables were measured using established scales:
- Patient safety competency was assessed using a 14-item scale.
- Perception of patient safety culture was measured with a 35-item questionnaire covering nine domains.
- Safety control was evaluated using a seven-item scale.
- Safety education was quantified by the number of patient safety training sessions attended in the past year. All scales utilized a 5-point Likert response format, and their reliability was confirmed with high Cronbach’s alpha coefficients.
Key Findings: The study yielded several significant findings:
- There were significant positive correlations among the frequency of attending safety education, the perception of patient safety culture, safety control, and patient safety competency.
- Crucially, the number of safety education briefings attended did not directly influence patient safety competence or safety control.
- However, safety education for nurses was found to indirectly influence patient safety competence via the mediating effects of the perception of patient safety culture and safety control. This means that frequent participation in safety education strengthens a nurse’s perception of patient safety culture, which then positively impacts their safety control and, ultimately, their patient safety competency.
- The hypothesized model effectively explained 38% of the variance in nurses’ patient safety competency.
Discussion and Implications: The findings underscore the paramount importance of cultivating a strong positive safety culture and empowering nurses with a robust sense of safety control to enhance their patient safety competency. While the study revealed that safety education itself did not have a direct impact on competency, its vital role in shaping nurses’ perceptions of safety culture and fostering safety control cannot be overstated.
The authors suggest that the lack of a direct correlation between safety education frequency and competency might stem from the content and teaching methods currently employed, which often involve one-sided lectures or online formats that may not be sufficiently engaging or practical. Consequently, the study advocates for hospital policymakers to develop long-term, continuous quality education programs for nurses, with content tailored to their specific needs and practical challenges.
To establish an effective patient safety culture, healthcare organizations need to implement actions that encourage event reporting and non-punitive responses to errors. Furthermore, systematic training is essential to improve nurses’ awareness of safety culture, given its close link to safety control. For strengthening safety control, a career-specific approach is recommended, as novice nurses may require different interventions compared to experienced ones. The study emphasizes that a change in perception ultimately leads to a change in behavior, advocating for educational programs that focus on recognizing the importance of safety culture for new nurses and addressing real-life scenarios for experienced staff. Overall, healthcare institutions should prioritize fostering a positive safety culture through leadership, open communication, and institutional policies that empower nurses to proactively address safety concerns.
Limitations: The study acknowledges certain limitations, including its focus on personal characteristics rather than broader environmental factors such as national or hospital medical policies, which also influence patient safety capabilities. Additionally, the study did not differentiate between qualitative differences in various types of safety education (e.g., workshops vs. online lectures), nor did it account for nurses’ actual safety-related behaviors in clinical practice. Future research is encouraged to address these aspects for a more comprehensive understanding.
Reference: Choi, J.-h., & Kim, K. (2024). A structural equation model for the patient safety competency of clinical nurses. PeerJ, e18462. https://doi.org/10.7717/peerj.18462
