Patient safety value, safety attitude and safety competency among emergency nurses in China: A structural equation model analysis.

Abstract

We aim to determine the levels of patient safety value, safety attitude and safety competency and to explore the associations among these variables in emergency nurses in China. Studies have focused on the individual characteristics of nurses as influencing factors of patient safety but not on the factors that may affect patient safety competency in the context of Chinese culture, such as safety value and safety attitude. A cross-sectional survey was conducted among emergency nurses in 22 hospitals. The final model had acceptable fit indices (χ2 /df = 3.512 < 5; CFI = 0.955 > 0.9; TLI = 0.942 > 0.9; IFI = 0.955 > 0.9; RMSEA = 0.068 < 0.08 [90% CI, 0.059 to 0.077]). A fully adjusted model was also tested, and the effects among variables were consistent with the hypothesized model. The SEM results showed that patient safety values had a significant direct effect on safety competency (b = .407, p < .001) and safety attitude (b = .656, p < .001). Patient safety attitude had a significant direct effect on safety competency (b = .493, p < .001). Patient safety values had an indirect effect on safety competency through safety attitude, and the total effect of safety values on safety competency was 0.730. Chinese nurses are at a moderate level of patient safety attitude and competency. Emergency nurses' safety value and safety attitude can be direct predictors of patient safety competency, and safety value can indirectly predict their patient safety competency through safety attitude. Strengthening safety value is a critical step toward improving patient safety competency. Hospital administrators and educators should construct a patient safety culture that is guided and driven by appropriate values and ensure the development of necessary competencies in nurses.