Patient safety culture, missed Nursing care and its reasons in Obstetrics

Silva, Silvana Cruz da; Morais, Bruna Xavier; Munhoz, Oclaris Lopes; Ongaro, Juliana Dal; Urbanetto, Janete de Souza; Magnago, Tânia Solange Bosi de Souza

doi:10.1590/1518-8345.4855.3461

Silvana Cruz da Silva

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.

Universidade Franciscana, Centro de Ciências da Saúde, Santa Maria, RS, Brazil.

3 Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

https://orcid.org/0000-0002-4563-3704

Bruna Xavier Morais

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.

https://orcid.org/0000-0002-0446-9231

Oclaris Lopes Munhoz

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.

https://orcid.org/0000-0001-8901-7148

Juliana Dal Ongaro

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.

https://orcid.org/0000-0003-0058-0132

Janete de Souza Urbanetto

Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-4697-1641

Tânia Solange Bosi de Souza Magnago Corresponding author: Tânia Solange Bosi de Souza Magnago E-mail: magnago.tania@gmail.com https://orcid.org/0000-0002-5308-1604

Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.

https://orcid.org/0000-0002-5308-1604

Corresponding author: Tânia Solange Bosi de Souza Magnago E-mail: magnago.tania@gmail.com https://orcid.org/0000-0002-5308-1604

Authors’ contribution:

Study concept and design: Silvana Cruz da Silva, Tânia Solange Bosi de Souza Magnago. Obtaining data: Silvana Cruz da Silva, Tânia Solange Bosi de Souza Magnago. Data analysis and interpretation: Silvana Cruz da Silva, Tânia Solange Bosi de Souza Magnago. Statistical analysis: Silvana Cruz da Silva, Janete de Souza Urbanetto, Tânia Solange Bosi de Souza Magnago. Obtaining financing: Silvana Cruz da Silva, Tânia Solange Bosi de Souza Magnago. Drafting the manuscript: Silvana Cruz da Silva, Bruna Xavier Morais, Oclaris Lopes Munhoz, Juliana Dal Ongaro, Tânia Solange Bosi de Souza Magnago. Critical review of the manuscript as to its relevant intellectual content: Silvana Cruz da Silva, Bruna Xavier Morais, Oclaris Lopes Munhoz, Juliana Dal Ongaro, Janete de Souza Urbanetto, Tânia Solange Bosi de Souza Magnago.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Associate Editor: Andrea Bernardes

Dimensions of the HSOPSC^* * HSOPSC = Hospital Survey on Patient Safety Culture	% of answers positive
Patient Safety Culture in the units	34.9
Organizational learning	56.9
Expectations of supervisors' safety promotion actions	50.0
Teamwork in the unit	43.1
Frequency of notified events	43.0
Opening for communication	40.0
Changeover of internal transfers	37.2
Teamwork between hospital units	31.8
Feedback of information communication about errors	31.5
General Perception of Patient Safety	27.2
Professionals/Staffing	25.9
Hospital management support for PS	23.6
Non-punitive responses to errors	9.1

Nursing Care	Often/Always performed
Nursing Care	N	%
Assessment of vital signs as prescribed.	61	98.4
Capillary blood glucose monitoring as prescribed.	59	95.2
Assessment of the patient's condition at each shift, identifying their care needs.	56	90.3
Focused reassessment, according to the patient's condition.	55	88.8
Care with venous access and infusion, according to the institution's rules.	55	88.8
Hand hygiene.	55	88.8
Assessment of the effectiveness of the drugs administered.	53	85.5
Complete record in the patient's medical record of all the necessary data.	51	82.3
Emotional support to the patient and/or family.	51	82.3
Guidelines to patients and family members regarding routines, procedures and care provided.	49	79.0
Requests for administration of prescription drugs W/N are met in fifteen minutes.	48	77.4
Use of preventive measures for patients at risk of falling.	47	75.8
Planning and teaching the patient and/or family for hospital discharge.	47	75.8
Bathing/Patient hygiene/Measures to prevent skin injuries.	46	74.2
Administration of the medications within 30 minutes before or after the prescribed time.	46	74.1
Hydration of the patient, when adequate, offering fluids orally or administering through the tube.	45	72.6
Care of skin lesions/wounds.	44	70.9
The answer to the patient's call is within five minutes.	44	70.9
Offering meals to the patients who eat by themselves.	44	70.9
Walking three times a day or as prescribed.	42	66.7
Water balance control: inputs and outputs.	40	64.5
Sitting the patient out of bed.	40	64.6
Participation in discussion of the interdisciplinary team on patient care, if it occurs.	33	53.2
Sanitizing the patient promptly after each elimination.	31	50.0
Feeding the patient or administering the diet by tube, on time.	31	50.0
Changing the patient's position every two hours.	30	48.4
Airway aspiration.	27	43.6
Oral hygiene.	26	42.0

Reasons for omitting care	Significant ratio/ Moderate ratio
Labor resources	N	%
Inadequate staffing.	53	85.4
Inadequate staffing for assistance or administrative tasks (e.g., inadequate number of clerks/secretaries, nursing assistants, technicians or nurses).	50	80.7
Large number of admissions and discharges.	43	69.3
Unexpected increase in volume and/or severity of the patients in the unit.	41	31.1
Emergency situations of the patients (e.g.: worsening of a patient's condition).	40	64.6
High number of professionals who work sick or with health problems (which prevents them from performing the functions for which they were hired).	36	58.1
High number of nurses with little professional experience.	25	40.3
The professionals have more than one job, which reduces their commitment/attention/concentration to perform the assistance.	18	29.0
Material resources
The medications were not available when needed.	39	62.9
The physical plant of the unit/sector is inadequate, which makes it difficult to provide assistance to patients in isolation or in more distant areas.	38	61.3
The materials/equipment did not work properly when needed.	35	56.4
The materials/equipment were not available when needed.	33	53.2
Communication
The distribution of patients by professional is not balanced.	33	53.2
Tension /Conflict or communication problems within the Nursing Team.	33	53.2
Tension/Conflict or communication problems with the Medical Team.	33	53.2
The nursing assistant did not report that the assistance was not performed.	33	53.2
Tension/Conflict or problems communicating with other departments/support sectors.	30	48.4
The professional responsible for the care was outside the unit/sector or was not available.	27	43.6
Other team professionals did not provide assistance at the time it was needed (e.g.: the physical therapist did not assist in the patient's walking).	26	42.0
The team members do not help each other.	26	42.0
Lack of standardization for performing procedures/care actions.	24	38.7
The changeover from the previous shift or from the units that refer patients is inappropriate.	23	37.1
Ethical dimension
The professional has no ethical posture and has no commitment and involvement with the work and/or the institution.	29	46.8
The professional who did not provide care is not afraid of punishment/dismissal due to job stability.	27	43.5
The Nursing professional is negligent (laziness, lack of attention or insensitivity).	24	38.7
Institutional Management/Leadership
Lack of preparation of nurses to lead, supervise and conduct teamwork.	36	58.1
Lack of in-service education about the care to be performed (which includes training, updating, improvement and professional development).	29	46.8
Lack of motivation for work (due to low wages and/or lack of professional appreciation).	25	40.3

Variables	Nurses				Nursing technicians and assistants				p^* * Mann-Whitney's U Test;
Variables	Mean (LL-UL)	SD^‡ ‡ SD = Standard Deviation;	Median	Min-Max^§ § Min-Max = Minimum - Maximum;	Mean (LL-UL)	SD	Median	Min-Max	p^* * Mann-Whitney's U Test;
HSOPSC^\|\| \|\| HSOPSC = Hospital Survey on Patient Safety Culture	27.0 (19.9-34.2)	16.1	24.6	2.1-58.3	39.8 (33.4-46.3)	17.2	40.6	4.9-72.9	0.712
Missed Nursing care	47.1 (42.7-51.4)	10.4	45.4	27.9-69.3	36.9 (33.1-40.6)	10.6	37.1	20.7-67.1	0.702
Reasons for omission	64.2 (58.6-69.8)	13.3	63.8	42.0-86.6	64.0 (58.1-69.9)	16.6	67.9	25.9-89.2	0.416
Communication	2.4 (2.2-2.7)	0.5	2.4	1.4-3.4	2.3 (2.1-2.6)	0.7	2.5	1.0-3.5	0.107
Material resources	2.7 (2.5-3.0)	0.7	2.7	1.0-3.7	2.8 (2.5-3.0)	0.7	2.7	2.71,0-4.0	0.742
Labor resources	2.7 (2.5-3.0)	0.5	2.7	7.9-3.5	2.8 (2.6-3.0)	0.7	3.0	1.0-3.7	0.526
Ethics	2.4 (1.9-2.8)	1.0	2.2	1.0-4.0	2.4 (2.1-2.8)	1.0	2.3	1.0-4.0	0.996
Institutional Management/ Leadership	2.4 (0.1-2.8)	0.8	2.5	1.0-4.0	2.5 (2.1-2.8)	1.0	2.7	1.0-4.0	0.171

Variables	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20
1. Hospital Survey on Patient Safety Culture	1
2. Teamwork between hospital units	.657^† * Mann-Whitney's U Test;	1
3. Expectations of supervisors' safety promotion actions	.638^† * Mann-Whitney's U Test;	.436^† * Mann-Whitney's U Test;	1
4. Organizalional leaming	.731^† * Mann-Whitney's U Test;	.496t	466^† * Mann-Whitney's U Test;	1
5. feedback of Information communication about errors	.571^† * Mann-Whitney's U Test;	.350	.451^† * Mann-Whitney's U Test;	.414^† * Mann-Whitney's U Test;	1
6. Opening for communication	.731^† * Mann-Whitney's U Test;	.471 ^† * Mann-Whitney's U Test;	^† * Mann-Whitney's U Test; .576^† * Mann-Whitney's U Test;	.453^† * Mann-Whitney's U Test;	.555^* * HSOPSC = Hospital Survey on Patient Safety Culture	1
7. Prfessionals/Staffing	-.088	.186	^† * Mann-Whitney's U Test; .-.064	.-.027	-.045	-0.71	1
8. Non-punitive responses to error	.268^* * HSOPSC = Hospital Survey on Patient Safety Culture	.257^* * HSOPSC = Hospital Survey on Patient Safety Culture	.222	.205	.085	.082	-0.11	1
9. Hospital management support for PS	.608^† * Mann-Whitney's U Test;	.3581	.512^† * Mann-Whitney's U Test;	.509t	.311^* * HSOPSC = Hospital Survey on Patient Safety Culture	.349^† * Mann-Whitney's U Test;	-.005	.107	1
10. Teamwork in the unit	.700t	.341t	-236	.460t	.362^† * Mann-Whitney's U Test;	.548^† * Mann-Whitney's U Test;	-134	.183	.405^† * Mann-Whitney's U Test;	1
11. Changeover of internai transfers	.648t	.396	^† * Mann-Whitney's U Test; .282^* * HSOPSC = Hospital Survey on Patient Safety Culture	.393^† * Mann-Whitney's U Test;	.297^* * HSOPSC = Hospital Survey on Patient Safety Culture	.417^† * Mann-Whitney's U Test;	-.084	.272^* * HSOPSC = Hospital Survey on Patient Safety Culture	.304^* * HSOPSC = Hospital Survey on Patient Safety Culture	.453^† * Mann-Whitney's U Test;	1
12. General Perception of pateint Safety	.572^† * Mann-Whitney's U Test;	361	^† * Mann-Whitney's U Test; .281^* * HSOPSC = Hospital Survey on Patient Safety Culture	.562^† * Mann-Whitney's U Test;	.448^† * Mann-Whitney's U Test;	.292^* * HSOPSC = Hospital Survey on Patient Safety Culture	.109	.108	.563^† * Mann-Whitney's U Test;	.495^† * Mann-Whitney's U Test;	.377^† * Mann-Whitney's U Test;	1
13.frequency of notified events	.356^† * Mann-Whitney's U Test;	.074	.018	.190	.119	.039	-.045	-.034	.128	.235	.179	.207	1
14. Missed Nursing care	-393^† * Mann-Whitney's U Test;	-.238	-.271^* * HSOPSC = Hospital Survey on Patient Safety Culture	-519^† * Mann-Whitney's U Test;	-.191	-.223	-.185	-.120	-.332^† * Mann-Whitney's U Test;	-.277^* * HSOPSC = Hospital Survey on Patient Safety Culture	-.323^* * HSOPSC = Hospital Survey on Patient Safety Culture	-.366^† * Mann-Whitney's U Test;	-.2351	1
15. Reasons for omission	-.192	-.117	-.222	-238	-.132	-.238	.009	.077	-.158	-.078	-.100	-.006	.076	.257^* * HSOPSC = Hospital Survey on Patient Safety Culture	1
16. Communication category	-.224	-.230	-.260^* * HSOPSC = Hospital Survey on Patient Safety Culture	-.192	-.157	-.263^* * HSOPSC = Hospital Survey on Patient Safety Culture	-.034	.068	-.215	-.095	-.072	-.012	.040	.311^* * HSOPSC = Hospital Survey on Patient Safety Culture	921^† * Mann-Whitney's U Test;	1
17. Material resources category	-.289	-.118	-.265^* * The correlation is significant at the 0.05 level; to 1.00) correlation(18)	-.170	-.141	-.249	0.23	-.100	-.124	-.178	-.189	-.069	-.103	.093	.685^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.616^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	11
18. Labor resources category	-.109	-.046	-.119	-.160	-.064	-.200	-.061	.071	-.074	-.059	-.172	-.098	.120	.157	.803^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.618^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.565^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	1
19. Ethical category	59	-.044	-.110	-.250	-.123	-.117	.051	.063	-.121	-.002	.063	.030	.082	.218	.836^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.750^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.442^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.522^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	1
20. Institucional Management/Leadership category	-.004	.029	-.142	-.172	-.022	-.133	.083	.234	-.089	.080	-.086	.080	-.0.86	.254^* * The correlation is significant at the 0.05 level; to 1.00) correlation(18)	.810^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.682^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.376^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.666^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	.667^† † The correlation is significant at the 0.01 level. Weak (0.10 to 0.39), moderate (0.40 to 0.69) and strong (0.70	1

[1] Corresponding author: Tânia Solange Bosi de Souza Magnago E-mail: magnago.tania@gmail.com https://orcid.org/0000-0002-5308-1604

Brasil

Brasil

Patient safety culture, missed Nursing care and its reasons in Obstetrics^* * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), PDJ-Pós-Doutorado Júnior, Grant # 159929/2018-0, Brazil.

Objective:

Method:

Results:

Conclusion:

Brasil

Brasil

Patient safety culture, missed Nursing care and its reasons in Obstetrics* * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), PDJ-Pós-Doutorado Júnior, Grant # 159929/2018-0, Brazil.

Objective:

Method:

Results:

Conclusion:

Patient safety culture, missed Nursing care and its reasons in Obstetrics^* * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), PDJ-Pós-Doutorado Júnior, Grant # 159929/2018-0, Brazil.