Knowledge and Attitude of Nurse’s on Patient safety: A Systematic Review

 

VKSK Priyanka Kavuluru

Dept of Obstetric and Gynecological Nursing, Shri Mata Vaishno Devi College of Nursing (SMVDCON), Kakryal, Jammu, J and K.

*Corresponding Author E-mail: kavulurupriyanka@gmail.com

 

ABSTRACT:

Background of the review: Patient safety culture reflects the perception of processes, norms, and attitudes relating to a culture of preventable errors shared by health professionals in the delivery of care. Developing a culture of safety is a core element of many efforts to improve patient safety and care quality. Aim: The aim of the current review is intended (a) to assess the knowledge of nurses on patient safety (b) to assess the attitude of nurses on patient safety in clinical practice. Methods: The narrative conceptual synthesis method was used to review quantitative studies reporting sources of attitude of nurses towards patient safety culture. The search also was limited to studies conducted between 2011 and 2021 (10 years). The keywords include “patient safety culture”, “patient safety”, “attitude of nurses”, “clinical”, “hospitals” and “health care settings” in various combinations. Finally, 28 studies were identified, of which, 07met the set criteria. The review studies targeted on the student nurses, graduated nurses and nurses practicing in any patient care settings also included the data regarding patient safety culture.  The researcher screened the literature and extracted the data. Results: The review results show that the nurses are having sufficient to good level of knowledge regarding patient safety with good practices. The attitude of nurses varies from 50%negative, 50% favorable to positive attitude regarding patient safety. Conclusion: Patient safety is a global health strategy and an ascribe of all health care systems. Nurses spend the maximum time round the clock in coordinating and providing care to the patients are highly involved in strengthening the safety web of patient care. Thus, the nursing staff must update their knowledge, foster a positive attitude regarding patient safety, and embody it into their practice to promote patient safety.

 

KEYWORDS: Patient safety, Patient safety culture, Nurses attitude, safety attitude, safety attitude questionnaire.

 

 


INTRODUCTION:

“Take care of the patient and everything else will follow

Thomas Frist M.D.”

 

Patient safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. It is fundamental to delivering quality essential health services.

 

To ensure successful implementation of patient safety strategies we need clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed.1 The International Council of Nurses posits that nurses ought to protect patient rights, anywhere and at any time.2 Constructive attitudes, reflecting beliefs and actions, along with the ability to overcome barriers and further negotiate ethically challenging situations, are also crucial.3 therefore, patient safety culture should be adapted among all the health professional especially the primary care givers of the patients.

 

Exploration of nurses’ awareness on patient rights is important in shaping approaches to support nurses’ moral behavior at the patients’/families’ best interest. Although various aspects of patient rights have been extensively addressed in the literature, it is difficult to form a comprehensive and integrative picture on patient rights, especially from the viewpoint of nurses. Studies investigating particular aspects of the patient rights topic do not provide evidence on: which rights receive low priority compared to others; possible inconsistencies between education and clinical practice; or advocating for patient rights4.

 

Based on the above, I aimed to systematically review and synthesize a evidence on nurses knowledge and attitude regarding patient safety. As there are only a few researches carried out on patient safety concern among nurses there is paucity of literature.

 

Aim:

The aims of this review were: (a) to assess the knowledge of nurses on patient safety (b) to assess the attitude of nurses on patient safety in clinical practice.

 

Methods:

The narrative conceptual synthesis method was used to review quantitative studies reporting sources of knowledge and attitude of nurses regarding patient safety. A two-part analysis is presented. Knowledge regarding patient safety among nurses was the main focus of the first analysis. Identifying the attitude of nurses regarding patient safety was the emphasis of the second analysis. 

 

Search strategy:                                           

The researcher searched the literature using different keywords and combinations of keywords (Boolean operators) in data bases such as Pub Med, EMBASE, Cochrane, Science Direct, Google Scholar, and other sources such as Research Gate, other websites as they contained vast numbers of journals including nursing research journals. The search was limited to the studies conducted in India. The search was also limited to studies conducted between 2011 and 2021 (10 years). the keywords include “patient safety”, “knowledge”, “attitude”, “staff nurses”, “hospitals”, “health care settings” and “clinical practice” in various combinations. In order to ensure the quality of the findings, a systematic method of appraising the article was utilized. The entire process was independently completed by researcher.

 

Inclusion and exclusion criteria:

The review of literature from 2011 to 2021 included articles based on the following criteria:

 

Parameter

Inclusion criteria

Exclusion criteria

Population

·       Registered Nurses, Staff Nurses.

·       Nurses working in all health care settings caring for special populations also for e.g. psychiatric patients, heamodialysis unit etc.

·        Studies including other health care staff in sample along with nurses.

·   Studies published in other than English language.

Intervention

Knowledge and Attitudes of nurses towards patient safety in clinical practice.

·        Practice regarding patient safety culture among Nurses.

·        Perception of patient safety culture        by Nurses.

Outcomes

Knowledge and attitude of Nurses on Patient Safety

Incident reports

 

Study Design

Randomized and Non randomized Controlled trial and Quasi experimental design

Case Report, Lack of rigorous description of the methodology and experimental set up impeding replicability.

 

Data Extraction:

Using a predefined protocol, researcher searched, collected, extracted and evaluated the information from each individual study included in the review as per the inclusion criteria. The disagreements that occurred during the extraction of the data were resolved by consultation with experts. The information extracted from the individual studies included; the name of the author including the year of publication, geographic location where the study was conducted, title of the study, sample size, research design of the study, the type of instrument used for data collection, attitude of nurses towards patient safety culture. The primary purpose of this systematic review was to identify the attitude of nurses towards patient safety culture. As described in the figure-1 a total of 07 studies were included for the review and ­­­­­­06 studies were excluded at different stages of evaluation. The details of the data extracted from the selected studies are given in Table 1.


 

Table 1: studies on attitude of nurses towards patient safety culture: included in Systematic Review

Author Details and Year of the study

Geographical Location

Title of the study

N

Research study design

Instrument/Tool

Knowledge regarding Patient safety

Attitude towards Patient Safety

AddisuDabiWakeID  et al5

2021

Oromia Regional State, Ethiopia

Knowledge, attitude, practice and associated factors towards patient safety among nurses working at Asella Referral and Teaching Hospital, Ethiopia: A cross-sectional study

172

cross-sectional study design

pretested questionnaire

 Good knowledge

positive attitude and good practice towards patient safety was 58.7%

Farhan F Alshammari et al 6

2020

Saudi Arabia

Knowledge, attitudes, and perception on patient safety among intern nurses athemodialysis unit.

118

A quantitative comparatice- correlational study design

Survey questionnaire

Good knowledge

Positive attitude

HenokBiresawa et al 7

2020

Gondar, ethiopia

Knowledge and attitude of nurses towards patient safety and its associated factors.

386

Cross-sectional study design

Pre-tested, structured and self-administered English version questionnaire

48.4% of the respondents were found to have good knowledge.

56.1% of the respondents had a favorable attitude regarding patient safety.

Saida El et al8

2019

Egypt

Nurses' Knowledge, Attitudes, and Skills towards Psychiatric Patients' Safety.

350

A cross-sectional

Psychiatric patient safety skills scale, and patient safety attitudes, skills and knowledge scale.

 

Sufficient knowledge

 

Negative attitude was detected towards the safety of psychiatric patients.

 

Shimaa Mohammed Hasballah et al 9

2019

Egypt

Assess Nurses’ Knowledge and Attitude for Patient Safety in Cardiac Catheterization Unit.

40

A descriptive research design

Structured interview sheet

Poor knowledge

(77.5%) of Nurses had negative attitude and (22.5%) of them had Positive attitude toward patient safety in cardiac catheterization unit

Samarpita Pramanik et al10

2016

Odisha

Knowledge and attitude of nursing personnel regarding patient safety

600

Descriptive research design

Self administered knowledge and attitude questionnaire 

The findings revealed that 70.8% of nursing personnel had moderately adequate knowledge 

60.8% had a favorable attitude regarding patient safety.

Feeba Geevarghese11

2012

Delhi

Knowledge and attitudes of nursing personnel regarding patient safety and rights in hospitals of Delhi.

200

Descriptive research design

Structured Knowledge Questionnaire

It was revealed that majority of nursing staff working in private hospitals had greater knowledge about patient safety and rights

Nursing staff  also had better patient-friendly attitude. 


Figure 1: Prisma flow Diagram of included and excluded studies

Source: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta -Analyses: The PRISMA Statement.  PLoS Med 6(7): e1000097. Doi:10.1371/journal. pmed1000097

 


RESULTS:

The details of the data extracted from the selected studies are given as below

 

Setting:

Seven quantitative studies conducted in various countries were included in this review. All the studies were conducted in different countries, special population and area of care.

 

Design and sample size:

All the studies included in the review were Descriptive, cross sectional studies and one Correlational study with sample sizes that ranged from 40 to 600 nurses.

 

Instrument:

For assessing the knowledge and attitude regarding patient safety, most of the studies utilized the structured patient safety pre-tested questionnaire, survey questionnaire and other instruments used is Psychiatric patient safety skills scale, and patient safety attitudes, skills and knowledge scale.

 

Knowledge of nurses on patient safety:

of the 07 studies, all the studies reviewed, the knowledge levels were good among nurses5,6,7,11, sufficient knowledge8, poor knowledge (9) and adequately moderate knowledge10. It was revealed that the maximum nursing personnel working in various clinical areas are having good and adequate knowledge regarding patient safety.

 

Attitude of nurses towards patient safety:

The attitude of nurses towards the patient safety was also assessed in the reviewed studies. Two studies showed nurses having good attitude and good practices towards patient safety5,6. Only 50% of nurses possessing favorable attitude7,10 and friendly attitude (11) towards patient safety. Only two studies showed negative attitude of nurses towards patient safety.

 

DISCUSSION:

The present review demonstrated the adequate to good knowledge of nurses towards patient safety. Insufficient evidence regarding attitude of nurses towards patient safety and its associated factors. The patient’s right to report and access the information about the care they received is given less priority. Moreover there is paucity of studies and literature addressing the knowledge and attitude of nurses towards patient safety was identified. The sampling technique used in the research settings are shortcomings of included studies. Majority of the studies utilized a pretested, self structured questionnaire with undefined validity may bring difference between the actual knowledge and attitude of nurses and self-reported levels while filling the tool. Good level of knowledge may not assure good practices by nurses for patient safety there may be so many associated factors or pre existing factors which will force the nurses to compromise while rendering services to patients. Obsolete knowledge regarding patient safety and lack of patient safety culture in health care settings increases the incidence of mishappenings in Patient safety practices.

 

CONCLUSION:

Although the reviewed studies result shows that the nurses are having good and sufficient knowledge regarding patient safety. The attitude of the nurses varies from negative to favorable in most of the studies.  Due to the noticeable methodological differences of the settings, geographical location, work environment, patient safety culture adopted by organizations and scarcity of literature we cannot draw firm conclusions and generalization of the results. The review suggests that patient safety culture adaptation only enhances the knowledge and attitude of nurses towards patient safety as patient safety is considered as a global health strategy.

 

CONFLICT OF INTEREST:

The author declares there was not any hindrance to write an article and to publish in your journal.

 

SOURCE OF FUNDING STATEMENT:

Self

 

ETHICAL CLEARANCE:

Since it is a self reviewed paper, ethical clearance is not required.

 

REFERENCES:

1.      Patient safety- Global action on patient safety. Report by the Director-General. Geneva: World Health Organization; 13 September 2019 [cited 2021 August 2021]. Available from http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_26-en.pdf.

2.      International Council of Nurses. The ICN Code of Ethics for Nurses: revised 2012. Geneva: ICN; 2012 [cited 2021 May 14]. Available from: https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfornurses_%20enpdf

3.      Turale S. Ethical dilemmas: The Challenge of advocating for human rights. International Nurs Rev. 2014;61(3):299-300. doi: 10.1111/inr.12130.

4.      Abedi G, Shojaee J, Moosazadeh M, Rostami F, Nadi A, Abedini E. Awareness and observance of patient rights from the perspective of Iranian patients: a systematic review and meta-analysis. Iran J Med Sci. 2017 [cited 2021 August 12];42(3):227-34. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429490/

5.      Addisu Dabi WakeID, Techane Sisay Tuji, Berhanu Kebe Gonfa, Eskeder Tsehayu Waldekidan, Etalem Demise Beshaw, Mohamed Ahimad Mohamed, Shawlem Tadese Geressu. Knowledge, attitude, practice and associated factors towards patient safety among nurses working at Asella Referral and Teaching Hospital, Ethiopia: A cross-sectional study; 1 July 2021[cited 2021 september 2021].  Available from https://doi.org/10.1371/journal.pone.0254122.

6.      H. Biresaw, N. Asfaw, F. Zewdu, Knowledge and attitude of nurses towards patient safety and its associated factors. International Journal of Africa Nursing Sciences.2020; doi: https://doi.org/ 10.1016/j.ijans.2020.100229.

7.      Alshammari FF, Ahamed ST, Sallam SA, Pasay-an EA. Knowledge, attitudes, and perception on patient safety among intern nurses at hemodialysis unit. Int J Health Allied Sciences .2020;9:353-358.

8.      Saida El Sayed Hassan Ibrahim El-Azzab and Azza Mohamed Abd El-Aziz. Nurses' Knowledge, Attitudes, and Skills towards Psychiatric Patients' Safety. IOSR Journal of Nursing and Health Science (IOSR-JNHS). May-June 2018;7 (3) Ver. I: 13-25.

9.      Shimaa Mohammed Hasballah, Olfat Abd Elgany Shaor, Mona Aly Mohamed and Ayman Khairy Mohamed. Assess Nurses’ Knowledge and Attitude for Patient Safety in Cardiac Catheterization Unit. Assiut Scientific Nursing Journal. December 2019;7(19) :151 – 159.

10.   Samarpita Pramanik, T. S. Ravikumar, Florence Segaran, Edwin Stephen, M.S. Knowledge and Attitude of Nursing Personnel Regarding Patient Safety. Indian Journal of Continuing Nursing Education. Jan - June 2016;17(1):38-44.

11.   Geevarghese F. Knowledge and attitude of nursing personnel regarding patient safety and rights in hospitals of Delhi. Nurs J India. 2012 Nov-Dec;103(6):276-8. PMID: 23923600.

 

 

 

 

 

Received on 09.12.2021         Modified on 22.01.2022

Accepted on 25.02.2022       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2022; 10(2):156-160.

DOI: 10.52711/2454-2652.2022.00041