The Impact of Nurses Clinical Decisions on Patient Safety and Quality of Care
Nurses' Clinical Decisions on Patient Safety and Quality of Care
DOI:
https://doi.org/10.54393/nrs.v5i2.165Keywords:
Clinical Decision-Making, Patient Safety, Safety Culture, Healthcare LeadershipAbstract
Patient safety (PS) and quality of care are central to healthcare delivery, with clinical decisions playing a pivotal role in influencing outcomes. Objective: To assess the impact of clinical decisions on PS culture and the quality of care in tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan, and to identify key predictors influencing these outcomes. Methods: A cross-sectional analytical study was conducted from January to April 2025 in three tertiary care hospitals of KPK. A total of 384 participants (192 healthcare providers and 192 patients) were enrolled. PS culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC), and patient satisfaction was evaluated using the PSQ-18. An audit of 450 clinical decisions was also conducted. Descriptive statistics and inferential statistics were employed for data analysis using SPSS version 26.0. Results: Experienced staff (>5 years) reported significantly higher PS scores (3.96 ± 0.49, p<0.001). ICU/Emergency Departments had higher safety perceptions compared to medical and surgical units (p=0.041). Teamwork climate (4.15 ± 0.47) and supervisor expectations (3.96 ± 0.59) were rated highest among safety dimensions. Guideline non-adherence was significantly associated with adverse events (12.3% vs. 4.5%, p=0.018). Teamwork score (OR: 1.78) and experience (OR: 2.33) emerged as strong predictors of high safety culture. Conclusions: It was concluded that clinical decisions significantly affect PS and quality of care. Enhancing teamwork and experience-based leadership can strengthen safety culture, reduce adverse events, and improve patient satisfaction.
References
Braithwaite J, Churruca K, Clay-Williams R, Cutler H, Ellis LA, Long JC et al. Health policy in Australia. In Research Handbook on Health Care Policy 2024 Apr 9 (pp. 347-373). Edward Elgar Publishing. doi: 10.4337/9781800887565.00024. DOI: https://doi.org/10.4337/9781800887565.00024
Waterson P, editor. Patient safety culture: theory, methods and application. Ashgate Publishing, Ltd. 2014 Nov.
World Health Organization. Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization; 2021 Aug.
Makary MA and Daniel M. Medical error-the third leading cause of death in the US. British Medical Journal. 2016 May; 353. doi: 10.1136/bmj.i2139. DOI: https://doi.org/10.1136/bmj.i2139
Parker D, Wensing M, Esmail A, Valderas JM. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. European Journal of General Practice. 2015 Aug; 21(sup1): 26-30. doi: 10.3109/13814788.2015.1043732. DOI: https://doi.org/10.3109/13814788.2015.1043732
Lee TS, Tzeng WC, Chiang HH. Impact of coping strategies on nurses' well‐being and practice. Journal of Nursing Scholarship. 2019 Mar; 51(2): 195-204. doi: 10.1111/jnu.12467. DOI: https://doi.org/10.1111/jnu.12467
Aboneh EA, Look KA, Stone JA, Lester CA, Chui MA. Psychometric properties of the AHRQ community pharmacy survey on patient safety culture: a factor analysis. British Medical Journal Quality & Safety. 2016 May; 25(5): 355-63. doi: 10.1136/bmjqs-2015-004001. DOI: https://doi.org/10.1136/bmjqs-2015-004001
Gleeson LL, McNamara J, Donworth E, Crowley EK, Delaney A, Sahm L et al. Healthcare provider perceptions of safety culture: A multi-site study using the safety attitudes questionnaire. Exploratory Research in Clinical and Social Pharmacy. 2023 Mar; 9: 100228. doi: 10.1016/j.rcsop.2023.100228. DOI: https://doi.org/10.1016/j.rcsop.2023.100228
Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BioMed Central Health Services Research. 2006 Dec; 6: 1-0. doi: 10.1186/1472-6963-6-44. DOI: https://doi.org/10.1186/1472-6963-6-44
Li L, Wu HH, Huang CH, Zou Y, Li XY. Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China. The TQM Journal. 2023 Jul; 35(6): 1556-67. doi: 10.1108/TQM-02-2022-0061. DOI: https://doi.org/10.1108/TQM-02-2022-0061
Huang CH, Wu HH, Lee YC. The perceptions of patient safety culture: a difference between physicians and nurses in Taiwan. Applied Nursing Research. 2018 Apr; 40: 39-44. doi: 10.1016/j.apnr.2017.12.010. DOI: https://doi.org/10.1016/j.apnr.2017.12.010
Wu CF, Wu HH, Lee YC, Huang CH. What attributes determine overall satisfaction in patient safety culture? An empirical study of the perceptions of hospital staff in Taiwan. Journal of Testing and Evaluation. 2021 Jan; 49(1): 629-39. doi: 10.1520/JTE20180713. DOI: https://doi.org/10.1520/JTE20180713
Westat J, Sorra T, Famolaro M, Naomi M, Yount D. Transitioning to the SOPS™ Hospital Survey Version 2.0: What's Different and What To Expect, Part I: Main Report [Internet]. 2019 Sep.
Weng SJ, Kim SH, Wu CL. Underlying influence of perception of management leadership on patient safety climate in healthcare organizations-A mediation analysis approach. International Journal for Quality in Health Care. 2017 Feb; 29(1): 111-6. doi: 10.1093/intqhc/mzw145. DOI: https://doi.org/10.1093/intqhc/mzw145
Alhassan S, Kwashie AA, Paarima Y, Ansah Ofei AM. Assessing managerial patient safety practices that influence adverse events reporting among nurses in the Savannah Region, Ghana. Journal of Patient Safety and Risk Management. 2022 Oct; 27(5): 218-28. doi: 10.1177/25160435221123465. DOI: https://doi.org/10.1177/25160435221123465
Wang X, Chontawan R, Nantsupawat R. Transformational leadership: effect on the job satisfaction of Registered Nurses in a hospital in China. Journal of Advanced Nursing. 2012 Feb; 68(2): 444-51. doi: 10.1111/j.1365-2648.2011.05762.x. DOI: https://doi.org/10.1111/j.1365-2648.2011.05762.x
Kim SH and Weng SJ. Incorporating work experience of medical staff into patient safety climate management: a multi-group analysis. BioMed Central Health Services Research. 2018 Dec; 18: 1-9. doi: 10.1186/s12913-018-3747-9. DOI: https://doi.org/10.1186/s12913-018-3747-9
Lee YC, Shieh JI, Huang CH, Wang CY, Wu HH. Analyzing patient safety culture from viewpoints of physicians and nurses-a case of a regional teaching hospital in Taiwan. The Journal for Healthcare Quality (JHQ). 2017 Sep; 39(5): 294-306. doi: 10.1097/JHQ.0000000000000065. DOI: https://doi.org/10.1097/JHQ.0000000000000065
Tang YT, Wu HH, Lee YC, Huang CH. Evaluating the psychometric properties of the Chinese version of the Safety Attitudes Questionnaire among medical staff in Taiwan. Journal of Health Organization and Management. 2022 Dec; 37(1): 84-95. doi: 10.1108/JHOM-03-2022-0084. DOI: https://doi.org/10.1108/JHOM-03-2022-0084
Salas E, Bisbey TM, Traylor AM, Rosen MA. Can teamwork promote safety in organizations?. Annual Review of Organizational Psychology and Organizational Behavior. 2020 Jan; 7(1): 283-313. doi: 10.1146/annurev-orgpsych-012119-045411. DOI: https://doi.org/10.1146/annurev-orgpsych-012119-045411
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