Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses

Abstract

This study investigated the relationship among hospital nurses’ perceptions of a just culture, empowerment, and patient safety activities. It also determined the factors affecting the patient safety activities of nurses. This cross-sectional study included 189 nurses from four hospitals in South Korea. The survey was conducted from October to December 2019 using self-report questionnaires including items on socio-demographic characteristics, just culture, empowerment, and patient safety activities. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient, and multiple linear regression analysis with SPSS/WIN 25.0. Patient safety activities correlated positively with just culture (r = 0.369, p < 0.000) and empowerment (r = 0.38, p < 0.000). Additionally, empowerment (β = 0.213, p = 0.001) and just culture (β = 0.442, p < 0.000) had statistically significant effects on patient safety activities and explained about 19.5% of the variance in patient safety activities (F = 16.170, p < 0.001). The patient safety at medical institutions can be improved by cultivating a work environment that embraces a just culture and empowers nurses.

Factors Influencing Military Nurses' Reporting of Patient Safety Events in South Korea: A Structural Equation Modeling Approach

“…This research also found that just culture indirectly influences patient safety event reporting via safety climate. This finding is supported by the results of previous studies, which found that organizational factors, such as incident-reporting cultures, just cultures, and safety climates, have a significant effect on safety event reporting [7,15,45]. Our study also found that just culture has a direct effect on safety climate.…”

“…Therefore, in order to improve patient safety reporting by military hospital nurses, efforts to improve the overall system, create a safety culture, and to form a positive working environment should be conducted. Contrary to our expectations, as well as in contradiction to previous studies, just culture did not directly affect patient safety event reporting [7,15]. This study found that military nurses did not positively perceive the organization's just culture, which is consistent with previous studies on clinical nurses [15,48].…”

“…Contrary to our expectations, as well as in contradiction to previous studies, just culture did not directly affect patient safety event reporting [7,15]. This study found that military nurses did not positively perceive the organization's just culture, which is consistent with previous studies on clinical nurses [15,48]. Levine, Carmody, and Silk mentioned that current hospital organization cultures do not facilitate the reporting of medical errors because nurses do not associate organizational culture with patient safety [49].…”

“…The hypothesized model for this study was derived from both a literature review [9e13, 15,17,19,20] and the safety model developed by Neal et al [18]. Their model assumes that organizational climate (which encompasses leadership, work roles, and communication) significantly impacts the overall safety climate, while this climate then influences safety behaviors through its impact on staff members' relevant safety knowledge and motivation.…”

“…Furthermore, Lee et al, in a qualitative study of tertiary hospital doctors and nurses, reported themes like fear of blame, inappropriate responses, and the possibility of potential blame as factors that hinder safety event reporting in Korea [4]. Other studies have noted that an open and just culture increases nurses' patient safety activity and has a positive influence on their error reporting experiences [11,15]. Furthermore, others have reported that, within a just culture, authentic leadership has a positive impact on nurses' trust in their managers, which then provides them with a supportive practice environment, encourages them to speak up, and is able to accurately predict patient safety and quality of care [13].…”