4 The relationship between perceptions of caring relationships, person-centred climate, and medication administration in nursing: a mixed-methods study

Abstract

Medication administration errors are a severe safety issue, especially in hospitals. Analysis of the medication errors process is needed for quality care and patient safety. Previous studies show positive outcomes related to caring culture in nursing, such as patient satisfaction. However, little is known about the relationships between caring culture and medication administration errors. Therefore, we aimed to analyze the causes of medication administration errors, reasons for not reporting them, the estimated percentage of reported medication administration errors, and how this correlates with perceptions of caring cultures among nursing staff in hospital settings. We have conducted a sequential explanatory mixed-methods study. Quantitative data gathering included five psychometrically sound questionnaires with 790 nurses and nursing assistants working in 69 surgical and internal wards in 11 Slovenian hospitals. Perceptions of medication administration errors were measured using the Medication Administration Error Survey. Caring relationships were measured using the Caring Factor Surveys. The person-centred climate was measured using a Person-centred climate questionnaire - staff version. We have used descriptive and inferential statistics to describe and interpret data. Grounded theory was used in the qualitative strand. Data collected with open-ended questions and semi-structured interviews were coded using OpenCode 3.6 software. Quantitative and qualitative findings were integrated at the interpretation level. Quantitative results showed that medication administration errors mainly occur due to nurses’ resources and knowledge, working processes, and communication with physicians. Participants believed that underreporting is the result of fear and inadequate response. Perceptions of person-centred climate, safety climate, caring of provider, and caring by manager were linked with more significant medication error reporting. Core category lack of caring for patient safety with several categories emerged from qualitative analysis. The study showed a lack of caring relationships at the organizational and individual levels, various complex organizational and personal factors, errors occurrence, and underreporting. A caring culture was found to be the basis for safety; however, there are many other, mostly organizational, system issues. There is a need for a systematic approach in hospital settings.