Patient safety culture and its relationship with job satisfaction and adverse events among nurses working in emergency departments: A correlational descriptive study

doi:10.21203/rs.3.rs-2108805/v1

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Patient safety culture and its relationship with job satisfaction and adverse events among nurses working in emergency departments: A correlational descriptive study

https://doi.org/10.21203/rs.3.rs-2108805/v1

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Background and Aim

Patient safety culture is an important factor in the effort to reduce adverse events in the hospital and promote patient safety. The aim of this study was to investigate the relationship between patient safety culture, job satisfaction and adverse events among nurses working in the emergency department of Tabriz hospitals.

Materials and Methods

The current research was cross-sectional descriptive correlational study, which was conducted with the participation of 180 nurses working in the emergency department of Tabriz teaching hospitals who were selected using the quota sampling method. To collect data, demographic information form, HSOPSC patient safety culture questionnaire and job satisfaction questionnaire and adverse events in the past year form were used.

Results

The highest mean of patient safety culture was related to the work team within the units and the lowest mean was related to the dimension of non-punitive response to errors. 78.9 percent of nurses never reported falling in the past year. Most of the study participants stated that in the past year, they never experienced side effects of drugs (62.2 percent), medication errors (69.4 percent), reactions to injections or blood transfusions (74.4 percent), and injury to the patient. during care (75.6 percent). The results of Pearson's correlation test showed that there was a positive and significant correlation between the total score of patient safety culture and job satisfaction. The results of logistic regression analysis showed that each dimension of patient safety culture significantly predicts at least one of the adverse events.

Conclusion

The findings of the present study showed that the culture of patient safety and job satisfaction among nurses participating in this study was at an average level and the incidence of unwanted incidents was high. In addition, the results showed that there is a direct relationship between patient safety culture and job satisfaction and adverse events.

Patient safety culture

Job satisfaction

Adverse events

Emergency department

Nurses

Patient safety in health care is the cornerstone of quality in nursing care. It is one of the responsibility of nurses and an objective of the health organizations [1]. Patient safety has defined as “freedom from accidental or preventable injuries produced by medical care” [2]. The World Health Organization defines patient safety as: “the absence of preventable harm to patients and prevention of unnecessary harm by healthcare professionals” [3]. To achieve patient safety, healthcare organizations must have a strong safety culture. Safety culture is defined as "the values shared among organization members about what is important, their beliefs about how things operate in the organization,and the interaction of these with work unit and organizational structures and systems, which together produce behavioral norms in the organization that promotes safety" [4].

Emergency departments (EDs) are one of the most complex and dynamic units in the healthcare systems and the first place where many patients receive medical attention and are considered high-risk environments where adverse events (AEs) may occur [1, 5]. Assessing of emergency departments nurses' perception of patient safety culture can contributes to improving the quality of nursing care, reducing adverse events and can concentrate efforts to improve the quality of care provided to patients in emergency departments. Nurses in emergency departments face several challenges regarding how to provide safe care to patients [1].

Healthcare system in Iran has recently focused on emergency departments in hospitals, as the credibility of the hospitals has been associated with the credibility of their emergency unit. Accordingly, the course of emergency nursing MSc has been established in universities [6] and special duties have been introduced and explained to the emergency nurses [7]. In Iran health care system, nurses get permission to work at the bedside immediately after completing the 4-year university course and graduation; afterward, they are considered as the general nurse.[8] Similar to many other countries, they might even work in emergency unit of the hospitals due to the lack of enough experienced nurses [9]. This can be affects patient safety culture, adverse events and nurses job satisfaction [10].

Job satisfaction among nurses working in emergency departments is one of the major concerns of recent management [11]. Nursing researchers have described a diversity of definitions about nurses' job satisfaction that relate to the nursing profession. Based on a concept analysis study by Liu et al., job satisfaction was defined as “the feeling of pleasantness when occupational desires or needs have been fulfilled” [12]. The pandemic also may affect job satisfaction among nurses working in emergency departments. Findings of some studies indicate that it is necessary to improve nurses' job satisfaction and patient safety culture among nurses working in emergency departments [13].

An adverse event refers to harm resulting from healthcare delivery [14]. Harm is an outcome that negatively affects the patient's health or quality of life. It may result from the underlying medical condition or an adverse event, or a combination of these factors [14].

Based on a review of the literature, patient safety culture status in Iranian hospitals is not satisfactory. The overall patient safety culture score in Iranian hospitals that is determined through a meta-analysis of studies which used HSOPSC instrument to measure the perceptions of patient safety culture in Iran, is 50.1% [15]. Despite the fact that several studies have been conducted in the field of safety culture in general and in the emergency department around the world including Iran Healthcare system [1, 16–18] and its relationship with job satisfaction of the healthcare specialists and adverse events [11, 16, 19, 20], there is limited number of studies that have investigated the emergency nurses' perception of patient safety culture and its relationship with job satisfaction and adverse events at university hospital’s emergency departments. Working in Emergency department requires relatively special skills and commitments [21]. Therefore, it has a significant importance to study the patient safety culture among the emergency department’s health care professionals especially among the emergency nurses.

This research aimed at assessing nurses’ perception of patient safety culture and its relationship with job satisfaction and adverse events at university hospital’s emergency departments in Iran.

Design

The study uses a cross-sectional, descriptive correlational study design because the researcher will be gathering recorded information about their nurse participants without altering the study setting. In the other word, this was a cross-sectional and descriptive correlational study, in which nurses’ perception of patient safety culture and its relationship with job satisfaction and adverse events at university hospital’s emergency departments in Iran was examined. This design allows the strongest evidence-based information to answer the research question.

Sample And Setting

The study setting was hospital emergency department of Tabriz University of Medical Sciences in northwest Iran. In this study, the nurses employed in emergency departments in Tabriz, East Azerbaijan province of northwest Iran that had inclusion criteria were selected through proportionate randomized method. Firstly, hospitals of Tabriz were chosen. Afterward, sampling was done randomly according to each place's proportion.[22] Inclusion criteria were as follows: Having a desire to participate in the study, having at least six months of clinical work experience in the emergency department of one of the medical training centers of Tabriz University of Medical Sciences, holding at least B.Sc. degree in nursing.

Measuring Instrument

The instrument in this study was a four-section questionnaire. The Hospital Survey on Patient Safety Culture (HSOPSC), nurses' perceptions of job satisfaction, and adverse events questionnaires were used to collect data.

First section included demographic and professional variables of hospital emergency nurses (such as gender, age, sex, the highest education in nursing, workplace, history of clinical work in the hospital emergency, hours worked per week, etc.).

The second part included questions from the Persian version of the Hospital Survey on Patient Safety Culture (HSOPSC). Originally developed in the USA, is used worldwide and in the Middle East area to investigate and analyze PSC in hospital settings, particularly from the nurse's point of view [23]. Persian version of this was translated by Moghri et al. [24].

HSOPSC measured perception about safety culture, 42 items were used in 12 dimensions including "feedback". about errors", "communication openness", "staffing", "management support for patient safety", "transitions and handovers", "nonpunitive response to errors", "organizational learning", "supervisor/manager expectations", "teamwork across units", "teamwork within units", "frequency of events reported" and "overall perception of safety" [25]. The survey used a Likert scale of 5 points (from 1 means 'strongly disagree' to 5 means 'strongly agree').

Some items were represented as (from 1 means 'always' to 5 means 'poor'. The score of all items in each dimension reflected the hospital's strengths and areas that need enhancements. To categorize the average score, if the average score the dimension was less than 2.5, that dimension is considered Weak and were flagged as needing improvement, the score between 2.5–3.75 is considered average and the dimension score above 3.75 is considered good illustrated the positive areas representing the strongly perceived dimensions [26].

Section 3 was the nurses' perceptions of job satisfaction questionnaire [27]. It has 40 items with a six-point Liker scale (6 = fully agree, 5 = almost agree, 4 = slightly agree, 3 = slightly disagree, 2 = almost disagree, 1 = definitely agree).

According to this questionnaire, the minimum score is 40 and the maximum is 240; 240 means that the participant has the highest satisfaction score, whereas a score of 40 means that the lowest satisfaction score is obtained. The tool encompasses 9 measurable domains.

Section 4 included 6 adverse events include medication errors such as wrong prescription of medication (medicine error[ME]), patient falls (PF), side effects of medication, injury to the patient during care, infusion or transfusion reaction (IR/TR), and patients or their family complaints (PC/FC), which often occur in the emergency department [28]. The frequencies of adverse events were scored as ``never happen = 0'', ``several times a year = 1'', ''once a month or less = 2'', ''several times a month = 3”, “once a week = 4”, “several times a week = 5”, ``everyday = 6'' in the past year using a 7-level rating scale estimated by nurses [28].

Ethical Considerations

Before collecting the data, the Regional Research Ethics Committee of Tabriz University of Medical Sciences issued the permission for conducting this study (Approval ID: IR.TBZMED.REC.1398.949; Approval Date: 2019-12-09). A written informed consent was obtained from each study participant after explaining the objective and rationale of the study. All the data collected from participating nurses was recorded anonymously and confidentiality was assured throughout the study.

Sample Size

The sample size was calculated by the statistics specialist as 165 participants using the formula of \(n=\frac{{\left({Z}_{1-\frac{\alpha }{2}}+{Z}_{1-\beta }\right)}^{2}}{{\left(\omega \right)}^{2}}+3\) ; \(=\frac{{\left(1.96+1.28\right)}^{2}}{{\left(0.255\right)}^{2}}+3=165\). Taking an anticipated dropout rate of 5% into consideration, the sample size was increased to at least 174 participants. One hundred eighty participants were selected.

Data Collection And Analysis

Data collection was conducted during the several months. This was due to wave of the COVID-19 pandemic. To collect the data, the researcher attended in selected teaching hospitals from October 2020 to February 2021. After explaining the study purposes and method as well as obtaining written informed consent from them, participants were asked to fill out the questionnaires. They were assured that the data would only be used for study purposes and writing their names on the questionnaire was not needed. Before distributing the questionnaires, participants' agreement on the time of completion was obtained; therefore, they could fill out the forms at peace and without worrying about jeopardizing the patients' care.

Collected data were analyzed using IBM SPSS Statistics. It was done using independent t-test, Pearson, and Spearman correlation coefficient. P values less than 0.05 were considered to be significant.

Participant’s sociodemographic and professional characteristics

Participants' demographic and professional characteristics information is shown in Table 1. Totally, 205 emergency nurses of 10 hospitals were invited to participate in this study. Only 9 emergency nurses refused to participate in the study and did not complete the questionnaire. Their reason was working in a very busy and crowded unit (acceptance rate = 95.61%).[29] Of the participated nurses, 4 had not returned the questionnaire. Among the returned questioners, 12 were incomplete questions; as a result, the researcher excluded these from the study. Finally, 180 participants completed the questionnaire.

Table 1

Demographic and professional features of the sample (n = 180)
Gender	frequency	%
Male	71	39.4
Female	109	60.6
Marital status
single	79	43.9
married	101	56.1
Education
Bachelor degree	132	73.3
Master's degree (M.Sc.)	46	25.6
PhD	2	1.1
Worked in your current specialty or profession
Less than 5 year	85	47.2
5–10 years	37	20.6
11–20 years	46	25.6
21 years or more	12	6.7
Hours/week working in this hospital
42–54 hours per week	53	29.4
55–66 hours per week	64	35.6
67 or more hours per week	63	35

Based on the study findings, totally, 60.6% of emergency nurses were female. Of all participants, the mean age of the nurse respondents was 32.39 years (SD = 1.007). Regarding the length of time in the profession of nursing, most of the nurses participated in this study had worked less than 5 years (47.2%, n = 85).

The majority of the participants (35.6%, n = 64) worked about 55 to 66 h a week, while almost a third of them worked more than 66 h a week (Table 1).

Nurses' Perceptions Of Patient Safety Culture

The study results showed that the mean and standard deviation of the total patient safety culture score obtained by the nurses participating in this study was 113.97 ± 7.27 out of the obtainable range of 42–210. In addition, based on the normalized average, the highest and lowest scores were respectively related to the dimensions of teamwork within the departments (3.87 out of 5) and non-punitive response to mistakes (2.33 out of 5). More details related to scores of different dimensions of patient safety culture are provided in Table 2.

Table 2

Descriptive statistics of participating nurses' perceptions of patient safety culture based on HSOPSC dimensions (n = 180)
HSOPSC	Range	min	max	mean	SD	Normalized mean
Frequency of Event Reporting	3–15	7	15	7.98	2.35	2.66
Overall Perceptions of Safety	4–20	9	17	9.12	2.11	2.38
Supervisor/Manager Expectations & Action Promoting Safety	4–20	7	18	11.64	2.78	2.91
Hospital Management Support for Patient Safety	3–15	5	14	7.29	2.01	2.43
Organizational Learning-Continuous Improvement	3–15	7	16	7.23	1.7	2.41
Teamwork Within Units	4–20	10	21	15.5	2.72	3.87
Communication Openness	3–15	6	15	8.25	2.15	2.75
Feedback and Communication About Error	3–15	6	14	7.11	1.85	2.37
Non-punitive Response to Error	3–15	7	12	6.99	1.7	2.33
Staffing	4–20	6	13	11.28	1.56	2.82
Teamwork Across Hospital Units	4–20	7	14	10.7	1.67	2.67
Hospital Handoffs and Transitions	4–20	7	17	9.72	2.24	2.43
Overall score	42–210	111	148	113.97	7.27	2.7
HSOPSC, Hospital survey on patient safety culture; SD, Standard deviation

Nurses' Perceptions Of Job Satisfaction

In addition, according to our study results, the mean and standard deviation of the overall job satisfaction score of nurses participating in this study was 157.18 ± 7.42 out of the attainable range of 40–200. Also, the highest and lowest scores were related to the field of colleagues and the field of working conditions, respectively. More details related to the scores of different dimensions of job satisfaction are shown in Table 3.

Table 3

Descriptive statistics of the study participating nurses' perceptions of job satisfaction based on Job Satisfaction dimensions scores (n = 180)
Job Satisfaction domain	min	max	mean	SD
Salaries and benefits	12	21	12.75	1.83
appreciation and promotion	10	20	15.1	2.29
management and supervision	10	22	15.27	2.64
colleagues	12	21	17.28	1.86
job requirements	10	24	17	2.94
working conditions	7	19	12.46	2.62
the nature of the work	11	21	15.87	2.54
the organization's policies	9	21	14.71	2.85
job security	11	20	15.88	1.85
job satisfaction	14	21	16.82	1.44
Overall job satisfaction score	132	177	157.18	7.42
SD, Standard deviation

As the findings of the Table 4 show, in all the investigated adverse events, with the exception of "complaints from patients or their families", the majority of nurses stated that these adverse events did not happen to their patients during the last year. The largest number of participants (80 percent) stated that they had a complaint from the patient or the patient's family during the past year. Also, most of the nurses (78.9%) never reported falling in the past year. On the other hand, most of the study participants stated that in the past year, they never experienced side effects of medication (62.2%), medication error (69.4%), reaction to injection or blood transfusion (74.4%). and did not harm the patient during care (75.6 percent).

Table 4

Emergency department Nurse-estimated adverse events in the past year (n = 180)
Adverse events	Never happened n (%)	Had happened n (%)
Adverse events	Never happened n (%)	Several times a year	Once a month or less	Several times a month	Once a week	Several times a week	Everyday
medication error	125 (69.4)	29 (16.1)	20 (11.1)	3 (1.7)	2 (1.1)	1 (0.6)	0 (0.0)
Patient fall	142 (78.9)	22 (12.2)	15 (8.3)	1 (1.6)	0 (0.0)	0 (0.0)	0 (0.0)
Adverse Drug Events	112 (62.2)	27 (15.0)	28 (15.6)	8 (4.4)	5 (2.8)	0 (0.0)	0 (0.0)
Injury to the patient during care	136 (75.6)	25 (13.9)	18 (10.0)	1 (0.6)	0 (0.0)	0 (0.0)	0 (0.0)
Infusion or transfusion reaction	134 (74.4)	42 (23.3)	4 (2.2)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Patients or their family complaints	36 (20.0)	29 (16.1)	64 (35.6)	32 (17.8)	11 (6.1)	6 (3.3)	2 (1.1)

The results of Pearson's correlation coefficient showed that there was a difference between the total score of job satisfaction and teamwork within departments (r = 0.29, p = 0.001) and between hospital departments (r = 0.138, 0.043). =p) (not given here). Also, between the total score of patient safety culture with the total score of job satisfaction (r = 0.211, p = 0.014), appreciation and promotion components (r = 0.148, p = 0.038), colleagues (2/2 r = 0, p = 0.031) and job satisfaction (r = 0.21, p = 0.027) had a positive and significant correlation (Table 5).

Table 5

Correlation between dimensions of patient safety culture scores and job satisfaction dimensions score of the study participating nurses (n = 180)
Job Satisfaction domain	Total score of patient safety culture
Job Satisfaction domain	r	p-value
Salaries and benefits	0.083	0.27
appreciation and promotion	0148	0.047
management and supervision	0.006	0.93
colleagues	0.2	0.01
job requirements	0.011	0.87
working conditions	0.122	0.157
the nature of the work	0.124	0.156
the organization's policies	0.1	0.18
job security	0.129	0.15
job satisfaction	0.2	0.099
Overall job satisfaction score	0.151	0.042
r, The Pearson correlation coefficient

The results of multiple logistic regression models are presented in Table 6 (only significant items are given). By controlling the demographic variables of nurses and other variables as confounding variables in the regression model, the frequency of incident reporting had a significant relationship only with the adverse events of medication error (p < 0.05). Dimensions of general understanding of patient safety and management expectations and actions in order to improve patient safety had a significant relationship with adverse events of patient falls and reaction to injection or blood transfusion (p < 0.05).

Table 6

Logistic regression results of the relationship between dimensions of patient safety culture and adverse events (n = 180)
HSOPSC	B	SE	Sig*	Exp (B)	95% CI
HSOPSC	B	SE	Sig*	Exp (B)	Lower	Upper
medication error
Frequency of Event Reporting	0.257	0.092	0.005	0.77	0.64	0.93
Overall Perceptions of Safety	0.158	0.076	0.038	0.85	0.73	0.99
Supervisor/Manager Expectations & Action Promoting Safety	0.237	0.085	0.000	0.72	0.61	0.85
Organizational Learning-Continuous Improvement	0.383	0.137	0.005	0.68	0.52	0.89
Teamwork Within Units	0.2	0.098	0.037	0.81	0.67	0.99
Non-punitive Response to Error	0.466	0.144	0.001	0.936	0.47	0.83
Patient fall
Overall Perceptions of Safety	0.41	0.094	0.000	0.66	0.55	0.79
Supervisor/Manager Expectations & Action Promoting Safety	0.27	0.088	0.002	0.76	0.64	0.91
Teamwork Within Units	0.175	0.101	0.042	0.84	0.69	1.02
Adverse Drug Events
Hospital Management Support for Patient Safety	0.56	0.123	0.000	0.57	0.45	0.73
Communication Openness	0.28	0.092	0.002	0.75	0.63	0.9
Feedback and Communication About Error	0.2	0.1	0.048	0.82	0.67	0.999
Staffing	0.48	0.132	0.000	0.61	0.48	0.8
Teamwork Across Hospital Units	0.25	0.12	0.015	0.74	0.59	0.94
Hospital Handoffs and Transitions	0.32	0.1	0.002	0.73	0.6	0.88
Injury to the patient during care
Communication Openness	0.29	0.1	0.039	0.83	0.97	1.01
Feedback and Communication About Error	0.23	0.111	0.043	0.8	0.83	0.99
Non-punitive Response to Error	0.27	0.147	0.045	0.76	0.8	1.01
Staffing	0.38	0.138	0.005	0.68	0.76	0.89
Teamwork Across Hospital Units	0.25	0.13	0.048	0.78	0.68	1
Hospital Handoffs and Transitions	0.18	0.1	0.037	0.83	0.78	1.01
Infusion or transfusion reaction
Overall Perceptions of Safety	0.18	0.08	0.024	0.83	0.71	0.97
Supervisor/Manager Expectations & Action Promoting Safety	0.3	0.088	0.000	0.73	0.62	0.87
Non-punitive Response to Error	0.4	0.145	0.006	0.67	0.5	0.88
Hospital Handoffs and Transitions	0.3	0.1	0.004	0.73	0.6	0.9
Patients or their family complaints
Hospital Management Support for Patient Safety	0.66	0.148	0.000	0.51	0.38	0.69
Organizational Learning-Continuous Improvement	0.53	0.17	0.002	0.59	0.42	0.83
Communication Openness	0.26	0.114	0.02	0.76	0.61	0.96
*HSOPSC, Hospital survey on patient safety culture; CI, confidence interval ; , based on Binary Logistic Regression**

This descriptive correlational research study was carried out with the purpose of determining the relationship among patient safety culture, job satisfaction and adverse events at university hospital’s emergency departments in Iran.

The findings of the current study showed that the patient safety culture perceived by the nurses participating in this study was at an average level. Therefore, it seems necessary to take measures to improve the safety culture of nurses working in emergency departments. In the study of Gharaee et al. (2020), which was conducted with the aim of investigating the relationship between patient safety culture and adverse events in Hamedan hospitals, the overall score of patient safety culture was reported at an average level [26].

In addition, according to the results of the present study, the dimension of team work within departments with a score of 3.87 forms the highest and strongest dimension of safety culture. In the study of Chen in Taiwan, the dimension of teamwork within the units has gained the most points [30].

The findings of the current study showed that the nurses’ job satisfaction in this study was at an average level. The explanation for the findings may be related to the nurse’s works hours. In this study, 70.6% of the emergency nurses worked more than 56 h per week. However, the findings of the study by Suryani (2022) in Indonesia showed that the majority of the study nurses works 40–59 h per week [31].

Findings from this study indicated that nurses’ job satisfaction is positively correlated with overall perception of PSC. This is in line with earlier study results from the country and internationally[32, 33]. Despite to our results, findings from a study by Mansour et al. (2021) from Jordan indicated that nurses’ job satisfaction is not correlated with overall perception of PSC[11]. This ambiguous results need to more examination in future studies.

This study has both strengths and weaknesses. Strength of our study is that we have used a validated questionnaire that enabling us to make direct comparisons with results of previous studies. The selection of a cross-sectional study design with only one group of health professionals - nurses in Iran, Tabriz hospitals limits the results' scope and generalizability. The findings cannot necessarily be applied to other countries, medical practices such as nursing homes, outpatient’s settings, operating rooms, or healthcare professionals such as doctors, nursing assistants. In this cross-sectional study, the data was collected at a specific point in time, and it is not known whether the results would be similar over time specifically after COVID-19 pandemic. Similarly, this study is descriptive correlational design and not experimental, thus lacking the ability to establish causality between patient safety culture perceptions, error reporting, and patient safety. The study limitation is sample population of the study, which were nurses employed at Iran hospitals who agreed to complete the present study questioner. As all the data were collected through self-reporting technique, a real observation of a practice was not done. Finally, the present study results should be interpreted cautiously given the wave of the restriction of COVID-19 pandemic at the time of the study, which might have had an impact on the perceptions of Iranian emergency departments nursing staff on Patient safety culture.

Patient safety culture is one of the important issues for hospital management. The findings of the present study showed that the patient safety culture and job satisfaction in nurses participating in this study was at an average level and the incidence of adverse events was high. In addition, the results showed that there is a direct relationship between patient safety culture and job satisfaction and adverse events. Patient safety culture is an essential factor in the decreasing of medical errors and development of the institutions. Based on the study results, managers should pay attention to increasing job satisfaction among nurses and encourage them to document and communicate adverse events freely to improve the overall culture of patient safety. Finally, they should pay attention to the patients and their family compliant in emergency departments.

HSOPSC, Hospital Survey on Patient Safety Culture; WHO, World Health Organization; ED, Emergency Department

Ethics approval and consent to participate

The ethics committee of Tabriz University of Medical Sciences approved the study (Approval ID: IR.TBZMED.REC.1398.949; Approval Date: 2019-12-09). The study was carried out in accordance with the Declaration of Helsinki. Participants were provided with both verbal and written information about the research, and their voluntary participation, anonymity, and confidentiality were considered during the study process. Signed written informed consent was obtained from all participants.

Consent for publication

Not applicable

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to the confidentiality of the participants but are available from the corresponding author on reasonable request.

Conflicts of Interests

The Authors declare that there is no conflict of interest with this research.

Funding

Not applicable

Authors Contributions

Study design: ShSh; HR, NG, RSh. Data collection: HR; Analysis and interpretation of data: HR; drafting of the article: ShSh, HR; All authors reviewed the manuscript.

Acknowledgment

The research protocol was approved & Supported by Tabriz University of Medical Sciences. The authors express their gratitude to the participants who took part in the study.

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No competing interests reported.

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Patient safety culture and its relationship with job satisfaction and adverse events among nurses working in emergency departments: A correlational descriptive study

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Abstract

Background and Aim

Materials and Methods

Results

Conclusion

Introduction

Methods

Design

Sample And Setting

Measuring Instrument

Ethical Considerations

Sample Size

Data Collection And Analysis

Results

Participant’s sociodemographic and professional characteristics

Nurses' Perceptions Of Patient Safety Culture

Nurses' Perceptions Of Job Satisfaction

Discussion

Limitation Of The Study

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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