The Relationship Between Charge Nurses and Clinical Nurses' Perceptions of Patient Safety Culture and Leadership Practices

Öz

Background: A patient safety culture needs to be developed for quality and safe care in health care institutions. Executive nurses having transformational leadership behavior have an important effect on establishing a patient safety culture in hospitals. Objectives: The aim of this study is to reveal transformational leadership practices of unit charge nurses from their own perspective and the perspective of staff nurses they work with, to determine the patient safety culture perceptions of unit charge nurses and staff nurses, and to examine the relationship between transformational leadership practices and patient safety culture. Methods: This descriptive, relationship-seeking and cross-sectional study was conducted between March and June 2014 in four hospitals in Konya province. The sample of the study consisted of 70 unit charge nurses and 357 staff nurses working with these unit charge nurses. Participation rate in the study is 84.5%. Data were collected by using the Demographic Data Form, Leadership Practices Inventory and Patient Safety Culture Hospital Questionnaire. Means, t test, percentages, standard deviation and Spearman's tests were used in the analysis of the data. Results: According to the evaluations of the unit charge nurses and staff nurses; it was found that the unit charge nurses' averages scores for prodding others into action, encouraging others and questioning the process sub-dimension and total leadership practice were significantly higher than those of the staff nurses. Patient Safety Culture perceptions of unit charge nurses are higher than service nurses. According to the findings obtained from the study, there is a positive relationship between nurses' transformational leadership practices and patient safety culture. Conclusion: In the study, it has been shown that there is a positive relationship between nurses' transformational leadership practices and patient safety culture. In order to create a positive patient safety culture in the units of charge nurses, it is necessary to develop the unit charge nurses' transformational leadership practices.

Anahtar Kelimeler

• Nursing
• Patient Safety Culture
• Transformational Leadership Practice
• Charge Nurses
• Staff Nurses

Sorumlu Hemşireler ile Klinik Hemşirelerinin Hasta Güvenliği Kültürü Algıları ve Liderlik Uygulamaları Arasındaki İlişki

Öz

Giriş: Sağlık kuruluşlarında kaliteli ve güvenli bir bakım için hasta güvenliği kültürünün geliştirilmesi gerekmektedir. Hemşire yöneticilerinin dönüşümcü liderlik becerileri hasta güvenliği kültürünün oluşturulmasında oldukça önemlidir. Amaç: Bu çalışmanın amacı, servis sorumlu hemşirelerinin dönüşümcü liderlik uygulamalarını kendileri ve birlikte çalıştıkları servis hemşireleri gözüyle ortaya koymak, servis sorumlu ve servis hemşirelerinin hasta güvenliği kültürü algısını belirlemek ve dönüşümcü liderlik uygulamaları ile hasta güvenliği kültürü arasındaki ilişkiyi incelemektir. Yöntem: Tanımlayıcı, ilişki arayıcı ve kesitsel tipteki bu çalışma, Konya ilinde bulunan dört hastanede Mart-Haziran 2014 tarihleri arasında gerçekleştirilmiştir. Çalışmanın örneklemini 70 servis sorumlu hemşiresi ve bu hemşireler ile birlikte çalışan 357 servis hemşiresi oluşturmuştur. Çalışmaya katılım oranı %84.5'dir. Veriler, Demografik Veri Formu, Liderlik Uygulamaları Envanteri ve Hasta Güvenliği Kültürü Hastane Anketi kullanılarak toplanmıştır. Verilerin analizinde, ortalama, t testi, yüzde, standart sapma ve Spearman's testleri kullanılmıştır. Bulgular: Servis sorumlu hemşireleri ve servis hemşirelerinin değerlendirmelerine göre; servis sorumlu hemşirelerinin, başkalarını harekete geçirme, cesaretlendirme ve süreci sorgulama alt boyut puanları ve toplam liderlik uygulama puan ortalamaları servis hemşirelerinden anlamlı olarak daha yüksek olduğu bulunmuştur. Servis sorumlu hemşirelerinin hasta güvenliği kültürü algılarının daha yüksek olduğu belirlenmiştir. Çalışmada hemşirelerin dönüşümcü liderlik uygulamaları ile hasta güvenliği kültürü arasında pozitif bir bulunmuştur. Sonuç: Çalışmada hemşirelerin dönüşümcü liderlik uygulamaları ile hasta güvenliği kültürü arasında pozitif bir ilişki olduğu gösterilmiştir. Sorumlu hemşirelerinin birimlerinde olumlu bir hasta güvenliği kültürünü oluşturulabilmesi için servis sorumlu hemşirelerinin dönüşümcü liderlik uygulamalarının geliştirilmesi gerekmektedir.

Anahtar Kelimeler

• Hemşirelik
• Hasta Güvenliği Kültürü
• Dönüşümcü Liderlik Uygulamaları
• Sorumlu Hemşireler
• Hemşireler

Kaynakça

1. References 1. World Health Organization (WHO). Patient Safety: Making health care safer. Geneva:Licence:CCBY-NC-SA3.0IGO. 2017. Retrieved from: http://apps.who.int/iris/bitstream/10665/255507/ 1/WHOHIS-SDS-2017.11-eng.pdf.
2. 2. Vaismoradi M, Griffiths P, Turunen H. Transformational leadership in nursing and medication safety education: a discussion paper. J Nurs Manag. 2016;24(7):970-980. doi: 10.1111/jonm.12387.
3. 3. Kim KJ, Yoo MS, Seo EJ. Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian Nurs Res. 2018:12;121-126.
4. 4. Trus M, Doran D, Martinkenas A, Asikainen P, Suominen T. Perception of work-related empowerment of nurse managers. J Res Nurs . 2018;23(4):317-330.
5. 5. Kristensen N, Nymann C, Konradsen H. Implementing research results in clinical practice- the experiences of healthcare professionals. BMC Health Serv Res. 2016;16:48.
6. 6. Brewer CS, Kovner CT, Djukic M. Fatehi F, Greene W, Chacko TP, et al. İmpact of transformational leadership on nurse work outcomes. J Adv Nurs. 2016;2(11):2879-2893.
7. 7. Ree E,Wiig S.Linking transformational leadership, patient safety culture and work engagement in home care services. Nursing Open. 2020;7:256–264.
8. 8. Seljemo C, Viksveen P, Ree E. The role of transformational leadership, job demands and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study. BMC Health Services Research (2020);20:799. https://doi.org/10.1186/s12913-020-05671-y.

9. 9. McFadden KL, Stock GN. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health Care Manage Rev. 2015;40(1):24-34.
10. 10. Setiowati D. Analysis of head nurse on transformational leadership and patients safety culture in Palang Merah Indonesia (PMI) Hospital at Bogor, Indonesia. International Journal of Nursing and Health Services (IJNHS). 2020;3(1):471-476.
11. 11. García‐Sıerra and Fernández‐Castro. Relationships between leadership, structural empowerment, and engagement in nurses. J Adv Nurs. 2018;1–11. DOI: 10.1111/jan.13805.
12. 12. International Council of Nurses (ICN) International Council of Nurses 2019 Congress. Retrieved at: https://www.who.int/dg/speeches/detail/international-council-of-nurses-2019-congress.
13. 13. Joint Commission International (JCI) (2016). Patient safety systems (PS). Available at:https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/psc_for_webpdf.pdf?db=web&hash=1D79BF046A319BE99A20BE459982387F.
14. 14. Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf. 2011;20:338–43.
15. 15. Cloete L. Reducingmedication errorsin nursing practice. Nurs Stand. 2015;29(20):50-59.
16. 16. Taylor J, Dominic F, Agnew J. Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ Qual Saf. 2012;21(2):101–111.
17. 17. Oliveira RM, Leitao IM, Oliveira AC, Oliveira AC, Gazos DM, Silva LM et al. Evaluating the intervening factors in patient safety: focusing on hospital nursing staff. Rev Esc Enferm USP. 2015;49(1):104-13.
18. 18. DiCuccio MH. The relationship between patient safety culture and patient outcomes: a systematic review. J Patient Saf. 2015;11(3):135-42.
19. 19. Kouzes MJ, Posner BZ. The Leadership Challenge. 3rd edn. Jossey-Bass. A Wiley Imprint San Francisco. USA. 2003.p:48.
20. 20. Tremblay ML, Fernet C, Lavigne GL. Transformational and abusive leadership practices: impacts on novice nurses, quality of care and intention to leave. J Adv Nurs.2016;72(3):582-592.
21. 21. Janet B, John Terrance D, Bartman T, Cindy H, Lindsay L, Nadeem K, et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf. 2016;1:1-7.
22. 22. Enwereuzor IK, Ugwu LI, Eze OA. How transformational leadership ınfluences work engagement among nurses: does person–job fit matter? West J Nurs Res.2018;40:346–366.
23. 23. Feng X, Bobay K, Krejci JW, McCormick BL. Factors associated with nurses’ perceptions of patient safety culture in China: a cross-sectional survey study. J Evid Based Med 2012;5:50-56.
24. 24. LPI. Online-how many observers? (2018). Retrieved from: https://support.leadershipchallenge.com/s/article/lpi-online-selecting-observers.
25. 25. Duygulu S, Karabulut E, Abaan S, Kublay G. Reliability and Validity Assessment of the Leadership Practices Inventory for nurses in Turkey. Hacettepe University Faculty of Health Sciences Journal of Nursing, 2011;18(1);14-27.
26. 26. Bodur S, Filiz E. Validity and reliability of Turkish version of "hospital survey on patient safety culture" and perception of patient safety in public hospitals in Turkey. BMC Health Serv Res. 2010;10:28-36.
27. 27. Sorra J, Gray L, Streagle S, et al. AHRQ Hospital survey on patient safety culture: user’s guide. (Prepared by Westat, under Contract No. HHSA290201300003C). AHRQ Publication No. 15-0049-EF (Replaces 04-0041). Rockville, MD: Agency for Healthcare Research and Quality. January 2016.
28. http://www.ahrq.gov/professionals/quality-patientsafety/patientsafetyculture/hospital/index.html 28. McGuire E, Kennerly SM. Nurse managers as transformational and transactional leaders. Nurs Econ. 2006;24(4):179–185.
29. 29. Duygulu S, Kublay G. Transformational leadership training programme for charge nurses. J Adv Nurs. 2011;67(3):633–642.
30. 30. Okuyama JHH, Galvao TF, Silva MT. Healthcare professional’s perception of patient safety measured by the hospital survey on patient safety culture: a systematic review and meta-analysis. ScientificWorldJournal. 2018. https://doi.org/10.1155/2018/9156301.
31. 31. Yılmaz A, Duygulu S. Investigation of Nurses’ Perceptions of Patient Safety Culture and Effective Factors. Journal of Health and Nursing Management, 2019;6:171-185.
32. 32. Famolaro T, Yount ND, Hare, R, et al. Hospital Survey on Patient Safety Culture 2018 Database Report, Appendixes, Parts II and III (Appendixes for AHRQ Publication No.18-0025-EF). (Prepared by Westat, Rockville, MD, under contract No. HHSA290201300003C). Rockville, MD: Agency for Healthcare Research and Quality; March 2018.
33. 33. Bodur S, Filiz E. A survey on patient safety culture in primary health care services in Turkey. Int J Qual Health Care. 2009;21(5):348-355.
34. 34. Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of safety climate and safety performance in hospitals. Health Serv Res.2009;44(2):399–421.
35. 35. Griffiths P, Recio-Saucedo A, Dall’Ora C, Briggs J, Maruotti A, Meredith P et al. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs. 2018;74(7):1474-1487.
36. 36. Hwang J. What are hospital nurses’ strengths and weaknesses in patient safety competence? Findings from three Korean hospitals. Int J Qual Health Care. 2015;27(3):232–238.
37. 37. General Directorate of Health Services Health Quality and Accreditation Department HQS-Hospital (Version-5, Revision-00) 1.Pressure: Ankara, July 2017 ISBN: 978-975-590-558-7.
38. 38. Joint Commission International (JCI). A complimentary publication of The Joint Commission. The essential role of leadership in developing a safety culture. 2017;(57)1:1-8.
39. 39. Hamadan M, Khraisat O, Eves C. Patient safety culture structures and outcomes: a sample from ısolation units at saudi arabia. International Journal of Nursing and Health Science (IJNHS). 2017;4(1):8-15.
40. 40. Ree E. What is the role of transformational leadership, work environment and patient safety culture for person-centred care? A cross-sectional study in Norwegian nursing homes and home care services. Nursing Open. 2020; 00:1–9. https://doi.org/10.1002/nop2.592