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Fauziningtyas R, Chan CM, Pin TM, Dhamanti I, Smith GD. Psychometric properties of the Indonesian version of the nursing home survey on patient safety culture. Int J Older People Nurs 2023; 18:e12553. [PMID: 37334471 DOI: 10.1111/opn.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/29/2023] [Accepted: 05/07/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION The development of resident safety culture in nursing homes (NH) represents a major challenge for governments and NH owners, with a requirement for suitable tools to assess safety culture. Indonesia currently lacks suitable safety cultures scales for NH. OBJECTIVES To evaluate the psychometric properties of the translated Indonesian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC-INA). METHODS This study was a cross-sectional survey conducted using NHSOPSC-INA. A total of 258 participants from 20 NH in Indonesia were engaged. Participants included NH managers, caregivers, administrative staff, nurses and support staff with at least junior high school education. The SPSS 23.0 was used for descriptive data analysis and internal consistency (Cronbach's alpha) estimation. The AMOS (version 22) was used to perform confirmatory factor analysis (CFA) on the questionnaire's dimensional structure. RESULTS The NHSOPSC CFA test originally had 12 dimensions with 42 items and was modified to eight dimensions with 26 items in the Indonesian version. The deleted dimensions were 'Staffing' (4 items), 'Compliance with procedure' (3 items), 'Training and skills' (3 items), 'non-punitive response to mistakes' (4 items) and 'Organisational learning' (2 items). The subsequent analysis revealed an accepted model with 26 NHSOPSC-INA items (root mean square error of approximation = 0.091, comparative fit index = 0.815, Tucker-Lewis index = 0.793, CMIN = 798.488, df = 291, CMIN/Df = 2.74, GFI = 0.782, AGFI = 0.737, p < 0.0001) and a factor loading value of 0.538-0.981. Expert feedback confirmed the relevance of the instrument items (content validity index [CVI] = 0.942). CONCLUSION The modified NHSPOSC-INA model with eight dimensions (26 items) fits the data set in the context of Indonesian NH services. IMPLICATIONS FOR PRACTICE The NHSPOSC-INA is a valid and reliable instrument for assessing staff perceptions of NH resident safety culture in Indonesia. The questionnaire can now be used to evaluate interventions for resident safety in Indonesian NH.
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Affiliation(s)
- Rista Fauziningtyas
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Chong Mei Chan
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Tan Maw Pin
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Inge Dhamanti
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
- La Trobe University, School of Psychology and Public Health, Melbourne, Australia
| | - Graeme D Smith
- Caritas Institute of Higher Education, Hong Kong, Hong Kong
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Estabrooks CA, Duan Y, Cummings GG, Doupe M, Hoben M, Keefe J, Poss JW, Song Y, Squires JE, Wagg A, Norton PG. Changes in Health and Well-Being of Nursing Home Managers from a Prepandemic Baseline in February 2020 to December 2021. J Am Med Dir Assoc 2023; 24:148-155. [PMID: 36584970 DOI: 10.1016/j.jamda.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. DESIGN Repeated cross-sectional survey. SETTING AND PARTICIPANTS A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month. METHODS We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory-exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form-8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity. RESULTS The final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference -0.26, 95% CI -0.47 to -0.06; P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P < .001), and SF-8 mental health (mean difference -6.49, 95% CI -9.60 to -3.39; P < .001). CONCLUSIONS AND IMPLICATIONS Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.
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Affiliation(s)
- Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Malcolm Doupe
- Max Rady College of Medicine, Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Janice Keefe
- Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Wagg
- Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Desmedt M, Petrovic M, Beuckelaere P, Vandijck D. Assessing Resident Safety Culture in Six Nursing Homes in Belgium. J Patient Saf 2021; 17:e1209-e1215. [PMID: 29596134 DOI: 10.1097/pts.0000000000000476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA). METHODS A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017. RESULTS Highest mean scores were found for "feedback and communication about incidents" (mean [SD] = 4.20 [0.58]), "overall perceptions of resident safety" (mean [SD] = 4.07 [0.52]), and "supervisor expectations and actions promoting resident safety" (mean [SD] = 4.04 [0.70]). The lowest mean score was found for "staffing" (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions "teamwork" and "supervisor expectations and actions promoting resident safety." Finally, the present study scored higher on the dimensions "teamwork," "nonpunitive response to mistakes," "handoffs," "feedback and communication about incidents," and "communication openness" than the benchmarking data from the Nursing Home Comparative Database. CONCLUSIONS More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.
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Affiliation(s)
- Melissa Desmedt
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Mirko Petrovic
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Petra Beuckelaere
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Vandijck
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
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Workplace Integrated Safety and Health Program Uptake in Nursing Homes: Associations with Ownership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111313. [PMID: 34769830 PMCID: PMC8583467 DOI: 10.3390/ijerph182111313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 12/22/2022]
Abstract
Workers in nursing homes are at high risk of occupational injury. Understanding whether—and which—nursing homes implement integrated policies to protect and promote worker health is crucial. We surveyed Directors of Nursing (DON) at nursing homes in three US states with the Workplace Integrated Safety and Health (WISH) assessment, a recently developed and validated instrument that assesses workplace policies, programs, and practices that affect worker safety, health, and wellbeing. We hypothesized that corporate and for-profit nursing homes would be less likely to report policies consistent with Total Worker Health (TWH) approaches. For each of the five validated WISH domains, we assessed the association between being in the lowest quartile of WISH score and ownership status using multivariable logistic regression. Our sample included 543 nursing homes, 83% which were corporate owned and 77% which were for-profit. On average, DONs reported a high implementation of TWH policies, as measured by the WISH. We did not find an association between either corporate ownership or for-profit status and WISH score for any WISH domain. Results were consistent across numerous sensitivity analyses. For-profit status and corporate ownership status do not identify nursing homes that may benefit from additional TWH approaches.
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Brito Fernandes Ó, Lobo Julião P, Klazinga N, Kringos D, Marques N. COVID-19 Preparedness and Perceived Safety in Nursing Homes in Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial Phases of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157983. [PMID: 34360296 PMCID: PMC8345424 DOI: 10.3390/ijerph18157983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022]
Abstract
(1) Background: Nursing homes’ preparedness in managing a public health emergency has been poor, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in southern Portugal, including staff’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey of staff was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the staff survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were areas for improvement among nursing homes’ contingency plans. We identified teamwork as an area of strength for safety culture, whereas compliance with procedures and nonpunitive response to mistakes need improvement. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.
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Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093 Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Correspondence:
| | - Pedro Lobo Julião
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Nuno Marques
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
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López Gómez MA, Gundersen DA, Boden LI, Sorensen G, Katz JN, Collins JE, Wagner G, Vriniotis MG, Williams JA. Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods. BMJ Open 2021; 11:e045656. [PMID: 34145013 PMCID: PMC8215260 DOI: 10.1136/bmjopen-2020-045656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA. DESIGN Validation of an assessment scale using data from a cross-sectional survey. SETTING Nursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts. PARTICIPANTS 569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study. RESULTS Graded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics-M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, β1, β2, β3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation. CONCLUSIONS The WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.
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Affiliation(s)
- María Andrée López Gómez
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Leslie I Boden
- Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Glorian Sorensen
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Social and Behavioral Sciences, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie E Collins
- Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Wagner
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary G Vriniotis
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Ar Williams
- Health Policy and Management, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Williams JA, Vriniotis MG, Gundersen DA, Boden LI, Collins JE, Katz JN, Wagner GR, Sorensen G. How to ask: Surveying nursing directors of nursing homes. Health Sci Rep 2021; 4:e304. [PMID: 34136659 PMCID: PMC8177897 DOI: 10.1002/hsr2.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error. METHODS We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. RESULTS The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. CONCLUSION A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.
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Affiliation(s)
| | - Mary G. Vriniotis
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Daniel A. Gundersen
- Survey and Qualitative Methods CoreDana‐Farber Cancer InstituteBostonMassachusetts
| | - Leslie I. Boden
- Environmental HealthBoston University School of Public HealthBostonMassachusetts
| | - Jamie E. Collins
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Jeffrey N. Katz
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Gregory R. Wagner
- Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Glorian Sorensen
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
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Vrotsou K, Pérez-Pérez P, Alías G, Machón M, Mateo-Abad M, Vergara I, Silvestre C. Nursing Home Survey on Patient Safety Culture: Cross-cultural Validation Data From Spanish Nursing Homes. J Patient Saf 2021; 17:e306-e312. [PMID: 32251243 DOI: 10.1097/pts.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Developing an adequate patient safety culture is a relevant objective for all health care levels. The Nursing Home Survey on Patient Safety Culture (NHSOPS) is a 12-dimension tool assessing safety culture in nursing homes (NH) for elder people. The psychometric properties of its Spanish adaptation are evaluated in this study. METHODS Nursing homes with 15 beds or more, located in the Basque Country (North Spain), were invited in the study. All staff types were allowed to participate. Internal consistency was tested with Cronbach's α. Convergent and divergent validity with Spearman's correlations. Two-sample t test was used for known-groups validity. The NHSOPS dimensionality was tested with confirmatory factor analysis (CFA), and its stability in consecutive administrations (test-retest) was explored. RESULTS Five hundred fifty-three valid baseline and 83 retest replies were received. The data suggest that the NHSOPS can be represented by a 10-factor model. Two items (A6 and A10) had loadings of less than 0.12. The rest survey items obtained loadings of greater than 0.40. Estimated correlations supported the convergent and divergent validity of the survey. Managers and administrators, as well as staff considering their NH to be a safe place for residents, obtained higher NHSOPS scores, suggesting acceptable known-groups validity. On the other hand, test-retest variation was considerable. CONCLUSIONS The current data support a simpler model, similar to that of the Norwegian NHSOPS validation. The stability of the scale should be further assessed in a bigger sample. Test-retest reliability and developing an adequate scoring scheme are issues worth of further study.
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Affiliation(s)
| | - Pastora Pérez-Pérez
- Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla
| | - Gorka Alías
- Matia Fundazioa-Matia Instituto Gerontológico, Donostia-San Sebastián
| | | | | | | | - Carmen Silvestre
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Navarra, Spain
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Myhre J, Malmedal WK, Saga S, Ostaszkiewicz J, Nakrem S. Nursing home leaders' perception of factors influencing the reporting of elder abuse and neglect: a qualitative study. J Health Organ Manag 2020; ahead-of-print. [PMID: 32762219 DOI: 10.1108/jhom-02-2020-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice. DESIGN/METHODOLOGY/APPROACH A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses. FINDINGS Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect. ORIGINALITY/VALUE This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.
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Affiliation(s)
- Janne Myhre
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Karin Malmedal
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Susan Saga
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Geelong, Australia
- National Ageing Research Institute Inc, Parkville, Australia
| | - Sigrid Nakrem
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Perceived Patient Safety Culture in Nursing Homes Associated With "Nursing Home Compare" Performance Indicators. Med Care 2019; 57:641-647. [PMID: 31259786 DOI: 10.1097/mlr.0000000000001142] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, with several "Nursing Home Compare" performance indicators. We conducted the survey in 2017 using the Agency for Healthcare Research and Quality Survey on Patient Safety Culture for nursing homes to collect data on 12 core domains of safety culture scores. Survey data were linked to other nursing home files for multivariable regression analyses. RESULTS Overall, 818 of the 2254 sampled nursing homes had at least 1 completed survey returned for a response rate of 36%. After adjustment for nursing home, market, and state covariates, every 10 percentage points increase in overall positive response rate for safety culture was associated with 0.56 fewer health care deficiencies (P=0.001), 0.74 fewer substantiated complaints (P=0.004), reduced fines by $2285.20 (P=0.059), and 20% increased odds of being designated as 4-star or 5-star (vs. 1 to 3 star) facilities (odds ratio roughly=1.20, P<0.05). CONCLUSIONS Efforts to improve nursing home performance in patient safety culture have the potential to improve broad safety and quality of care measures encapsulated in the Nursing Home Compare publication.
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Bondevik GT, Hofoss D, Husebø BS, Deilkås ECT. The safety attitudes questionnaire - ambulatory version: psychometric properties of the Norwegian version for nursing homes. BMC Health Serv Res 2019; 19:423. [PMID: 31238991 PMCID: PMC6593577 DOI: 10.1186/s12913-019-4244-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting. Methods The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. Results Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting. Conclusions The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients. Electronic supplementary material The online version of this article (10.1186/s12913-019-4244-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gunnar Tschudi Bondevik
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Dag Hofoss
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bettina Sandgathe Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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12
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Wagner LM, Driscoll L, Darlington JL, Flores V, Kim J, Melino K, Patel HD, Spetz J. Nurses' Communication of Safety Events to Nursing Home Residents and Families. J Gerontol Nurs 2018; 44:25-32. [PMID: 28990635 DOI: 10.3928/00989134-20171002-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
Abstract
Although communication is an essential part of the nursing process, nurses have little to no formal education in how to best communicate patient safety event (PSE) information to nursing home (NH) residents and their family members. The current mixed-methods study tested an intervention aimed at educating nurses on how to communicate a PSE to residents/family members using a structured communication tool. Nurse participants improved their knowledge of PSE communication, especially about the cause of the event, what they would say to the resident/family member, and future prevention of the PSE. Through qualitative subgroup analysis, an increased number of empathic statements were noted post-intervention. The tool tested in this study provides structure to an important care process that is necessary for improving the culture of safety in NH settings. [Journal of Gerontological Nursing, 44(2), 25-32.].
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13
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Gartshore E, Waring J, Timmons S. Patient safety culture in care homes for older people: a scoping review. BMC Health Serv Res 2017; 17:752. [PMID: 29157257 PMCID: PMC5697159 DOI: 10.1186/s12913-017-2713-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, there has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls. However, research and developments in safety culture has predominantly taken place in hospital settings, with relatively less attention given to establishing a safety culture in care homes. Despite safety culture being accepted as an important quality indicator across all health and social care settings, the understanding of culture within social care settings remains far less developed than within hospitals. It is therefore important that the existing evidence base is gathered and reviewed in order to understand safety culture in care homes. METHODS A scoping review was undertaken to describe the availability of evidence related to care homes' patient safety culture, what these studies focused on, and identify any knowledge gaps within the existing literature. Included papers were each reviewed by two authors for eligibility and to draw out information relevant to the scoping review. RESULTS Twenty-four empirical papers and one literature review were included within the scoping review. The collective evidence demonstrated that safety culture research is largely based in the USA, within Nursing Homes rather than Residential Home settings. Moreover, the scoping review revealed that empirical evidence has predominantly used quantitative measures, and therefore the deeper levels of culture have not been captured in the evidence base. CONCLUSIONS Safety culture in care homes is a topic that has not been extensively researched. The review highlights a number of key gaps in the evidence base, which future research into safety culture in care home should attempt to address.
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Affiliation(s)
- Emily Gartshore
- Centre for Health Innovation Leadership and Learning, Nottingham Business School, Jubilee Campus, Nottingham, NG8 1BB UK
| | - Justin Waring
- Centre for Health Innovation Leadership and Learning, Nottingham Business School, Jubilee Campus, Nottingham, NG8 1BB UK
| | - Stephen Timmons
- Centre for Health Innovation Leadership and Learning, Nottingham Business School, Jubilee Campus, Nottingham, NG8 1BB UK
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14
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Banaszak-Holl J, Reichert H, Todd Greene M, Mody L, Wald HL, Crnich C, McNamara SE, Meddings J. Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey. J Am Geriatr Soc 2017; 65:2244-2250. [PMID: 28846129 DOI: 10.1111/jgs.15030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify facility- and individual-level predictors of nursing home safety culture. DESIGN Cross-sectional survey of individuals within facilities. SETTING Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. PARTICIPANTS Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. MEASUREMENTS Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. RESULTS Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. CONCLUSION Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture.
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Affiliation(s)
- Jane Banaszak-Holl
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.,Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Heidi Reichert
- Division of General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | - M Todd Greene
- Division of General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.,Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Heidi L Wald
- Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado
| | - Christopher Crnich
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.,William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
| | - Sara E McNamara
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.,Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, Medical School, University of Michigan, Ann Arbor, Michigan.,School of Medicine, University of Colorado, Aurora, Colorado
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15
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Lin SY, Tseng WT, Hsu MJ, Chiang HY, Tseng HC. A psychometric evaluation of the Chinese version of the nursing home survey on patient safety culture. J Clin Nurs 2017; 26:4664-4674. [DOI: 10.1111/jocn.13815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Shu-Yuan Lin
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Nursing Department; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Wei Ting Tseng
- Taipei City Hang-An Nursing Long-term Care Center; Taipei Taiwan
| | - Miao-Ju Hsu
- Department of Physical Therapy; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Hui-Ying Chiang
- Nursing Department; Chi Mei Hospital; Tainan Taiwan
- Department of Nursing; Chang Jung Christian University; Tainan Taiwan
| | - Hui-Chen Tseng
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Nursing Department; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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16
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Clark MA, Roman A, Rogers ML, Tyler DA, Mor V. Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 2014; 37:287-313. [PMID: 24500999 PMCID: PMC4380513 DOI: 10.1177/0163278714521633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets.
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Affiliation(s)
- Melissa A Clark
- School of Public Health, Brown University, Providence, RI, USA
| | - Anthony Roman
- Center for Survey Research, University of Massachusetts-Boston, Boston, MA, USA
| | | | - Denise A Tyler
- School of Public Health, Brown University, Providence, RI, USA
| | - Vincent Mor
- School of Public Health, Brown University, Providence, RI, USA
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17
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Nurses’ disclosure of error scenarios in nursing homes. Nurs Outlook 2013; 61:43-50. [DOI: 10.1016/j.outlook.2012.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/06/2012] [Accepted: 05/29/2012] [Indexed: 11/17/2022]
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18
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Relationship Between Nursing Home Safety Culture and Joint Commission Accreditation. Jt Comm J Qual Patient Saf 2012; 38:207-15. [DOI: 10.1016/s1553-7250(12)38026-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Kennerly SM, Yap TL, Hemmings A, Beckett G, Schafer JC, Borchers A. Development and psychometric testing of the nursing culture assessment tool. Clin Nurs Res 2012; 21:467-85. [PMID: 22523245 DOI: 10.1177/1054773812440810] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A valid and reliable nursing culture assessment tool aimed at capturing general aspects of nursing culture is needed for use in health care settings to assess and then reshape indicated troubled areas of the nursing culture. This article summarizes the Nursing Culture Assessment Tool's (NCAT) development and reports on a cross-sectional, exploratory investigation of its psychometric properties. The research aims were to test the tool's psychometric properties; discover its dimensionality; and refine the item structure to best represent the construct of nursing culture, an occupational subset of organizational culture. Empirical construct validity was tested using a sample of licensed nurses and nursing assistants (n = 340). Exploratory and confirmatory factor analysis (CFA) and logistical regression yielded a 6-factor, 19-item solution. Evidence supports the tool's validity for assessing nursing culture as a basis for shaping the culture into one that supports change, thereby accelerating, improving, and advancing nursing best practices and care outcomes.
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20
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Patient Safety Culture and the Association with Safe Resident Care in Nursing Homes. THE GERONTOLOGIST 2012; 52:802-11. [DOI: 10.1093/geront/gns007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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