Discussion
Diversity and quality elements in health service presentation are
prioritized as the health services improve and patients learn about
their rights. Patient safety is one of the most important issues among
these. Patient safety, in general sense, is the precautions taken by the
institution and workers at the phase of healthcare services presentation
in order to prevent the patient from getting harm. Complicated nature of
health care presentation might harm patients while they receive services
and could affect the formation of patient safety culture negatively.
Health care providers are aware of the fact that several cases that are
reflected on patients are experienced almost every day. These events
should not be ignored; they should be recorded, measured, analyzed, and
improved. 18-20 The present study found that the
existing practices and working conditions did not provide workers’
comfort at good level; and this case was found to affect patient safety
attitudes and practices.
Patient safety has become an irreplaceable component due to a number of
factors such as increase in the consciousness level, expectations, and
demand for health services in Turkey; technological developments and the
risks they create; increased cost of services and the burden it causes
in social security system; increase in the service quality standards;
increasing competition; legal responsibilities; and constantly improving
health policies. 21 A study on patient safety
conducted by Karaca and Arslan (2014: 14), which involved two private
hospital workers, reported no significant differences between gender and
marital status and patient safety in one hospital; but such difference
was found in the other hospital. 22 As for the present
study, I found no significant differences between the workers’ gender
and marital status according to their patient safety attitudes mean
scores. Gender and marital status are not major variables that affect
patient safety attitudes, which indicates why there is lack of
significant difference between patient safety attitudes mean scores.
Rızalar et al. (2016: 9) reported that nurses’ receiving education on
patient safety, departments where they worked, duration of working in
this profession, and type of duty significantly affected patient safety
culture levels. 23 A study conducted in Iran with 302
nurses working in university hospitals24 and a study
conducted in China with 463 nurses reported that the nurses’ perceptions
of patient safety culture were not at desired levels.25
In their study which evaluated safety attitudes of operating room nurses
and surgeons, Prati and Pietrantoni (2013: 669) found a statistically
significant difference between the occupation
groups.26 A comparison of the participants’ safety
attitudes according to the occupation groups indicated a statistically
significant difference between the groups’ mean scores in the present
study. Particularly the surgeons’ significantly higher safety attitudes
scale mean scores could result from a number of factors including being
more knowledgeable about patient safety and having more
responsibilities.
Working in shifts, working in changing times at daytime and nights have
negative effects on nurses’ biological rhythm, inner physiological
clock, and balance; a tired, sleepless nurse’s work affects patient care
and safety. Long working hours is a factor that affects workers’ working
performance and threatens worker and patient safety.27-29 In the study conducted with 393 nurses in the
USA, Rogers (2004: 202) reported that nurses working for more than 12
hours a day and more than 40 hours a week tended to make more mistakes
and could risk patient safety. 30 According to the
results of a study that investigated 31.627 registered nurses in general
medical/surgical units of 488 hospitals in 12 European Countries, lower
quality and safety and more care left undone were reported among
European registered nurses working shifts of ≥12 hours and those working
overtime. A 12-hour nursing shift pattern is an issue that should be
approached with caution. Further risks to quality would be caused with
the use of overtime working to mitigate staffing shortages or increase
flexibility .31The present study found that patient
safety attitudes mean scores of those who had both night and daytime
shift were found to be significantly higher than those who worked only
daytime.
Orientation training, which is complicated especially in terms of the
technical equipment used and processes, is highly important in enhancing
work adaptation of those who work in units that require special
knowledge and skills. One of these units are operating
rooms.32-35 Van Beuzekom et al. (2013: 112) reported
that lack of training and experience is the source of medical
errors.35 Patient safety attitudes mean scores of the
health professionals participating in this study were found to be
significantly different according to participation in orientation
programs and trainings on patient safety. Patient safety attitudes score
of those who participated in the orientation program and received
training on patient safety were found to be significantly higher.
Despite the fact that the health personnel participating in this study
defined the communication with team members and quality of cooperation
as “adequate” at various levels, it is considered that communication
and Teamwork Climate quality should be improved more. In the
perioperative care, where worker and patient traffic is very high and
where it is compulsory to work with technological tools and devices that
require special knowledge and skills, it is highly important to ensure
patient safety at optimum levels and enhance workers’ job satisfaction
and safety. An analysis of the Safety Attitudes Questionnaire (SAQ-OR)
mean scores in this study showed that stress recognition mean score was
the lowest, and that of safety climate was the highest. Although
workload and work tempo are very high in perioperative care, workers’
job satisfaction levels are considered to be high due to the nature of
the job done. Development of a common attitude towards patient safety
culture seems to be impossible without improving workers’ working
conditions. Health workers that have roles in perioperative care
(surgeon, anesthetist, operating room nurse, etc.) should develop a
behavior style about patient safety practices as a whole team, and
general standards of the institution should be identified and followed
clearly so that a homogenous structure could be formed about patient
safety. Despite this, particularly safe surgical practices should be
followed carefully, necessary interventions should be planned in order
to meet the identified requirements, and education programs should be
organized. Workers should be encouraged about error reporting; their
worries and fears about this issue should be
eliminated.36
The limitation of this study is that it was conducted in one hospital
and with a small group of participants. Such study should be carried out
in hospitals with various systems and in larger groups. This way, it
would be possible to raise awareness of the institutions and workers
about patient safety, which is a neglected issue.