The purpose of this study was to examine psychological safety as a mediator of the relationship between inclusive leadership and nurses' voice behaviors and error reporting. Voice behaviors were conceptualized as speaking up and withholding voice. Design: This correlational study used a web-based survey to obtain data from 526 nurses from the medical/surgical units of three tertiary general hospitals located in two cities in South Korea. Methods: We used model 4 of Hayes' PROCESS macro in SPSS to examine whether the effect of inclusive leadership on the three outcome variables was mediated by psychological safety. Findings: Mediation analysis showed significant direct and indirect effects of nurse managers' inclusive leadership on each of the three outcome variables through psychological safety after controlling for participant age and unit tenure. Our results also support the conceptualization of employee voice behavior as two distinct concepts: speaking up and withholding voice. Conclusions: When leader inclusiveness helps nurses to feel psychologically safe, they are less likely to feel silenced, and more likely to speak up freely to contribute ideas and disclose errors for the purpose of improving patient safety. Clinical Relevance: Leader inclusiveness would be especially beneficial in environments where offering suggestions, raising concerns, asking questions, reporting errors, or disagreeing with those in more senior positions is discouraged or considered culturally inappropriate.This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Aims: To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Design: A descriptive correlational study with cross-sectional data. Methods: Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics. Results: Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse manager ability, leadership and support of nurses, and nursephysician relationships were associated with job satisfaction only. A nursing foundation for quality of care was not uniquely associated with any of the three outcomes. Finally, nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave. Conclusion: Magnet-like work environments in Saudi Arabia are critical to recruiting and retaining nurses in a country with critical nursing shortages. Impact: This study addresses a gap in the literature regarding which components of the nurses' work environment are uniquely associated with emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Study results will assist Saudi hospital administrators and nurse leaders to develop recruitment and retention strategies by focusing on those work environment components most associated with nurse outcomes: participation in hospital affairs and staffing and resource adequacy.

Background To date, there has been no universal and validated tool for measuring safety culture in Korea. The Hospital Survey on Patient Safety Culture (HSOPSC), version 2.0 was released by the Agency for Healthcare Research and Quality in 2019, but it had not yet been translated and assessed for use in Korea. The aim of this study was to assess the content validity and other psychometric properties of the Korean-language version of the HSOPSC 2.0. Methods Instrument adaptation was performed using a committee-based translation, cognitive interviews, and expert panel reviews. Confirmatory factor analysis was conducted on data obtained through an online survey from 526 registered nurses who worked on medical-surgical units in three teaching hospitals in South Korea. Results One item was dropped during the translation and adaption phase of the study as being a poor fit for the Korean healthcare context, resulting in excellent content validity. Confirmatory factor analysis supported the factorial structure of the K-HSOPSC 2.0. Correlations with an overall measure of patient safety provided further evidence of construct validity. Additionally, in comparing the results of this current study to those from U.S. research using the HSOPSC 2.0, it was found that Korean nurses assigned less positive scores to all dimensions of patient safety culture. Conclusion Our findings provide evidence of the content validity, reliability, and construct validity of the K-HOSPSC 2.0 for measuring patient safety culture in South Korean hospitals. Hospital administrators can use this tool to assess safety culture and identify areas for improvement to enhance patient safety and quality of care.

Purpose Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses’ perceptions of patient safety using an innovative theoretical model. Design This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States. Methods Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses’ overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks. Findings All 11 safety culture factors were associated with nurse‐perceived patient safety, and all but two of the 11 factors uniquely predicted nurse‐perceived patient safety. Staffing adequacy was the strongest predictor of nurse‐perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process). Conclusions Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes. Clinical Relevance Organizational efforts should be made to provide sufficient staffing and hospital‐wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.

Background: Current health literature suggests that there has been a decline in the age of pubertal onset, and that pubertal development is influenced by social context. Unfortunately, contemporary Canadian-specific data have not been available. This study examined the odds of having entered puberty at various ages during adolescence, before and after controlling for the effects of family socioeconomic status and family structure. Methods: Longitudinal data for this study were drawn from the first four cycles of the National Longitudinal Survey of Children and Youth. The final sample consisted of 7,977 adolescents ranging in age from 10 to 17. Pubertal status of the participants was identified based on pubic hair, facial hair growth, and voice change, for boys; and pubic hair, breast development, and menstruation, for girls. Trajectories of pubertal development were analyzed with HLM growth curve modelling techniques. Results: The results indicated that, compared to boys, the odds of having entered puberty at age 13 were 6.45 times higher for girls and that girls go through puberty more quickly. Low family socioeconomic status and living with a stepfather were found to predict early onset of pubertal development. Conclusion: Contextual factors are related to pubertal development. Additional research is needed to develop a more solid understanding of how psychosocial factors interact to predict gendered patterns of pubertal development.