Positive Safety Attitudes Research Articles

The impact of safety attitude on hazard identification and risk analysis: evidence from event-related potentials

ABSTRACT A questionnaire survey and an event-related potential (ERP) experiment were used to reveal the impact of safety attitudes on risk perception. The results revealed that during hazard identification, the N130 amplitude of subjects with negative safety attitude was significantly higher, which implied that subjects with negative safety attitude were more likely to feel confused. During risk analysis, subjects with positive safety attitude were more inclined to overestimate the probability and damage degree of risks; subjects with positive safety attitudes displayed higher P150 and late positive potential amplitudes, which indicated that subjects with positive safety attitudes devoted more attention to risks in the early stage of risk analysis and had a more intense affective response in the later period. The risk judgment ability of subjects with positive safety attitude was affected by time pressure, and they exhibited higher risk judgment accuracy only under no time pressure.

Understanding the mechanism of safety attitude mitigates the turnover intention novice nurses via the person-centred method: A theory-driven, deductive cross-sectional study.

Examine profiles of safety attitudes among novices and explore whether profiles moderate the occupational identity-turnover pathway. Novice nurses face unique challenges in adopting positive safety attitudes, which influence outcomes like turnover. However, past research found only average levels of safety attitudes among novices, ignoring possible heterogeneity. Exploring whether meaningful subgroups exist based on safety perspectives and factors shaping them can provide insights to improve safety attitudes and retention. This study was designed as a cross-sectional investigation. Data were collected through the distribution of questionnaires. Descriptive statistics were first conducted, followed by latent profile analysis. We then carried out univariate analysis and ordinal multinomial regression to explore the factors shaping the different profiles. Finally, we examine the moderating effect of nurses' safety attitudes with different latent profiles on the relationship between professional identification and turnover intention. A total of 816 novice nurses were included. Three profiles were identified: high, moderate and low safety attitudes - higher attitudes were associated with lower turnover intention. Interest in nursing, health status, identity and turnover predicted profile membership. Moderate profile had a stronger buffering effect on the identity-turnover link versus high profile. Multiple safety attitude profiles exist among novice nurses. Certain factors like interest in nursing and occupational identity are associated with more positive safety profiles. Targeting these factors could potentially improve safety attitudes and reduce turnover among novice nurses. The moderating effects suggest that tailored interventions matching specific subgroups may maximize impact. Assessing subgroup attitudes enables tailored training for novices' specific needs, nurturing continuous improvement. Supporting early career development and role identity may strengthen retention intentions.

Menstrual Products: Attitudes About Taxation and Safety.

Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.

Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ).

Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes. Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis. Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability. Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.

The Affective Domain, Safety Attitude, and COVID-19 Prevention of Employees in the Petrochemical Industry.

The petrochemical industry is relatively strict regarding safety rules in the workplace. The workplace involves high-risk categories that are intolerant of human error. Especially in the current situation with COVID-19, concerns regarding prevention and safety in the workplace have increased. In light of this pandemic, the company must know whether all employees recognize the implementation of COVID-19 prevention. In addition, employee awareness of safety grounded in the affective domain of human thought is lacking. This study investigates the safety attitudes and COVID-19 prevention in the workplace based on the affective domain of employees. A survey questionnaire based on the Likert scale was utilized to collect data from 618 employees in the petrochemical industry. Descriptive analysis and analysis of variance were used to examine the data. The results reveal that employees in the petrochemical industry have a positive degree of responses to COVID-19 prevention, safety attitudes, and the affective domain, regardless of employment characteristics such as gender, age, position, and work experience. This study concludes that a positive affective domain of employees is followed by a positive safety attitude; thus, effective COVID-19 prevention was established in the workplace based on the perspectives and attitudes of the employees.

Examining construction group’s safety attitude resilience under major disruptions: An agent-based modelling approach

The construction industry is undergoing a series of disruptions and industrial changes. In disturbances of major events, construction workers’ safety attitude is at risk of being sabotaged due to factors such as resource reallocations, job insecurity, and mental pressure. The extend of such impact on the safety attitude by the disruptive event is complicated and complex as it depends on individual, group and external factors. This research extended and applied successfully the resilience engineering theory to model the response-recovery process of individual workers’ safety attitude under disruptions. With data collected from questionnaire surveys, an agent-based model was built to describe the dynamic changes of safety attitude under disruptions. The model examined the influence of factors at individual, group and external environmental aspects on both response and recovery stages. The results showed that construction workers’ safety attitude was resilient under external disruptions, and group and external level factors determined the length of recovery process, while individual factors determined if the safety attitude could be eventually fully recovered. When the safety parameters decreased by 28%, the construction group’s average safety attitude would not fully recover, unless compensated by the learning adaptability (LA) increasing by 10%. Furthermore, the results revealed that a high level of group interactions (doubled active-ratio) absorbed the external disruptions and the influence on construction workers with high degrees (doubled centre-value) had greater impact on the overall safety attitude resilience. This research shed lights on developing managerial suggestions to cope external disruptions and maintain the positive and stable safety attitude.

MEDICAL PERSONNEL PERCEPTION ON SAFETY ATTITUDE IN A TERTIARY TEACHING HOSPITAL IN MALAYSIA

Evaluation of the perception of safety attitudes among physicians and nurses in hospitals is important to ensure optimum patient care. The objectives are to assess the perception of medical personnel on safety attitudes at their workplace and to measure the correlation between domains and factors studied. A cross-sectional study involving 160 physicians and 304 nurses is conducted at a teaching hospital. A validated Safety Attitudes Questionnaire (SAQ) consisting of 6 domains is used to measure the perception of medical personnel on safety attitude at their workplace. The Mann-Whitney test was performed for the comparison of the mean scores between two categorical variables and Spearman’s correlation coefficient was used to evaluate the relationship between two numerical variables in terms of strength and direction. Job satisfaction (73.4 ± 17.6) and management perception (56.1 ± 12.9) domains recorded the highest and lowest mean scores respectively. Doctors showed the highest perceived positive attitudes towards stress identification (57.5%) whereas perception of management (9.4%) has the lowest score, and the nurses showed the highest perceived positive attitudes towards job satisfaction (74.3%), and a low score of perception of management (10.9%). Overall, climate safety and stress recognition domains showed significant correlations with age, level of education, years in specialty, and history of attending safety training. The study results indicated that the medical personnel had low positive safety attitudes towards the management perceptions domain. However, they reported a high level of job satisfaction domain. It is imperative for the management team to take the necessary steps to ensure the personnel develops a positive safety attitude.

On-road trust and perceived risk in Level 2 automation

To encourage appropriate use of driving automation, we need to understand and monitor driver’s trust and risk perception. We examined (1) how trust and perceived risk are affected by automation, driving conditions and experience and (2) how well perceived risk can be inferred from behaviour and physiology at three levels: over traffic conditions, aggregated risk events, and individual risk events.30 users with and without automation experience drove a Toyota Corolla with driving support. Safety attitude, subjective ratings, behaviour and physiology were examined.Driving support encouraged a positive safety attitude and active driver involvement. It reduced latent hazards while maintaining saliently perceived risks. Drivers frequently overruled lane centring (3.1 times/minute) and kept their feet on or above the pedals using ACC (65.8% of time). They comfortably used support on curvy motorways and monotonic and congested highways but less in unstable traffic and on roundabouts. They trusted the automation 65.4%, perceived 36.0% risk, acknowledged the need to monitor and would not engage in more secondary tasks than during manual driving.Trust-in situation reduced 2.0% when using automation. It was 8.2% higher than trust-in-automation, presumably due to driver self-confidence. Driving conditions or conflicts between driver and automation did not affect trust-in-automation.At the traffic condition level, physiology showed weak and partially counter-intuitive effects. For aggregated risk events, skin conductance had the clearest response but was discernible from baseline in < 50%. Pupil dilation and heart rate only increased with strong braking and active lane departure assist. For individual risk events, a CNN classifier could not identify risk events from physiology. We conclude that GSR, heart rate and pupil dilation respond to perceived risk, but lack specificity to monitor it on individual events.

Management support as a critical success factor (CSF) for changing worker’s safety attitude: a case of the Nigerian construction industry

Construction workers are often plagued with health and safety challenges on the job site especially in developing countries, largely owing to several factors that encourage poor safety practices on site. This study appraised workers’ perception of management engagement as a critical success factor (CSF) for the improvement of Nigerian construction employee’s safety attitude, using Nordic Occupational Safety Climate Questionnaire (NOSACQ-50). Findings from the study reveal that small scale and medium scale organizations dominate the industry in Nigeria, and a sizable number (20.4%) of the study participants are between 18 and 27 years of age with majority (74.7%) having work experience of 1–10 years. Management safety priority, commitment and competence and management safety empowerment were found to have strong positive correlation. In addition, the study revealed the existence of safety commitment disparity between clients of publicly and privately owned construction projects across the industry. To advance positive safety attitude across the construction industry in Nigeria, management commitment should be prioritised, while further study on workplace safety measures and workers’ safety engagement should be considered.

Patient safety attitudes in the next generation of healthcare providers. A review of the literature

Abstract Background A comprehensive understanding of the attitudes towards patient safety of the new generation of healthcare workers is fundamental not only for ensuring safe, high-quality care in the present but also for creating a safer healthcare setting in the future. This study aimed to systematically review the literature on patient safety attitudes of health professional students, new graduates, newly registered health professionals, and resident trainees, and to examine potential differences in this population with respect to year of study, specialty, and gender. Methods We searched four databases (i.e., PubMed, Web of Science, Scopus, and PsycInfo) up to 20/02/2020 and screened also additional sources, including weekly, automatic e-mailed search alerts up to 18/10/2020. Two reviewers independently performed all methodological steps (i.e., search, study selection, quality appraisal, data extraction and formal narrative synthesis), including a third reviewer in case of disagreement. Results We identified 6606 records, assessed 188 full-texts, and included 31 articles. Across studies, healthcare students and young professionals reported more positive patient safety attitudes in certain domains (e.g., teamwork climate, error inevitability, received patient safety training) but showed more negative attitudes in other areas (e.g., management support, safety climate, disclosure responsibility). Women and persons with more years of study and training demonstrated more positive attitudes towards patient safety. Conclusions Healthcare students should receive early curricular education in patient safety to build a solid foundation for the development of a strong and healthy safety culture. Understanding the differences in attitudes between aspiring healthcare providers from different areas is important to tailor teaching and training to the specific needs of certain populations. Key messages According to the reviewed literature, young healthcare students and professionals’ attitudes towards patient safety differed across domains. Institutions should increase education and training on patient safety for aspiring healthcare professionals, tailor them to the specific needs of this population, and monitor attitudes over time.

Systematic review: Nurses' safety attitudes and their impact on patient outcomes in acute-care hospitals.

AimsThe aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute‐care hospitals.DesignSystematic review with a narrative synthesis of the available data.Data sourcesData sources included MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Scopus and Web of Science Core Collection. Studies published up to March 2021 were included.Review MethodsThis review was conducted using guidance from the Joanna Briggs Institute for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines.ResultsA total of 3,452 studies were identified, and nine studies met the inclusion criteria. Nurses with positive safety attitudes reported fewer patient falls, medication errors, pressure injuries, healthcare‐associated infections, mortality, physical restraints, vascular access device reactions and higher patient satisfaction. Effective teamwork led to a reduction in adverse patient outcomes. Most included studies (N = 6) used variants of the Hospital Survey on Patient Safety Culture to assess nurses' safety attitudes. Patient outcomes data were collected from four sources: coded medical records data, incident management systems, nurse perceptions of adverse events and patient perceptions of safety.ConclusionA positive safety culture in nursing units and across hospitals resulted in fewer reported adverse patient outcomes. Nurse managers can improve nurses' safety attitudes by promoting a non‐punitive response to error reporting and promoting effective teamwork and good communication.

Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes.

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers’ wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.

Modification and validation of the travel safety attitude scale (TSAS) in international tourism: a reflective-formative approach

PurposeThis study modified, revised and validated a travel safety attitude scale (TSAS) using data collected from Canadian residents with out-of-country travel experiences.Design/methodology/approachThe authors proposed a higher component model (HCM) of TSAS, using a reflective-formative measurement model. In consultation with eight experts, a set of purified TSAS items was revised by checking wording and content. A questionnaire was administered to 531 participants using Amazon Mechanical Turk. The scale was validated with the partial least squares method of structural equation modelling (PLS-SEM), and the analysis was performed using SmartPLS 3.0.FindingsThe final results suggested a five-factor solution with 27 items, with a satisfactory level of reliability and validity at the first-order (reflective) and second-order (formative) constructs. The predictive validity result showed that TSAS is negatively related to tourist risk-taking intention.Research limitations/implicationsTSAS advanced research on travel safety attitudes and demonstrated the feasibility of using PLS-SEM in examining the Type II model. Future studies can focus on replicating the study in other countries, adding more variables for predictive validity tests and examining the interrelationship with affective attitudes.Practical implicationsThe authors suggested a more proactive approach to assess tourist safety attitudes based on travel safety information (TSI), health concern (HC), vulnerability to crime (VTC), personal safety (PES) and police safety (PS), listed in descending order of importance.Originality/valueThe study results provide directions for destination marketing organizations to allocate resources to maintain a positive travel safety attitude from potential and current tourists.

Food safety and evaluation of intention to practice safe eating out measures during COVID-19: Cross sectional study in Indonesia and Malaysia

The COVID-19 pandemic has altered consumers' relationship with food, whether through shopping, increased home cooking, taking pre-cautionary measures during food shopping, food delivery and whilst dining out. This study aims to examine the impact of COVID-19 pandemic on consumers' food safety knowledge, attitude and practices and to identify the predictors of food safety practices during COVID-19. An online survey was conducted and received valid responses from 987 respondents. Data were analysed using descriptive statistics, non-parametric tests, Spearman's rho correlation and multiple regression. The Theory of Planned Behaviour (TPB) model was used to investigate the intention to practice safe eating out measures during COVID-19. The mean food safety knowledge score was 6.37 ± 1.37 (9.00 = highest score) of which 91.3% of total respondents from Indonesia and Malaysia scored ≥5 points. Consumers also demonstrated positive food safety attitude (4.06 ± 0.99) and reported high frequencies in conducting food safety practices (4.03 ± 0.82) during COVID-19. The TPB has provided valuable framework for understanding consumers' intention to practice safe eating out measures during COVID-19. The multiple regression model explained 63% and 73% of the variance in adherence to safe eating out practices in Indonesia and Malaysia and (p < 0.05) respectively. All the TPB antecedents i.e. attitude, subjective norms and perceived behavioural control were identified as significant predictors on consumers' eating out practices. This suggests that consumers with positive food safety attitude and strong family norms were more likely to adhere to safe eating out measures (e.g. selection of clean and less crowded restaurants, practicing hand hygiene, wearing masks and practising social distancing). The findings also suggest that to fully adhere to the safe practices, it is important to have sufficient support from restaurant staff to ensure social distancing and to provide adequate handwashing facilities. This is the first study to provide new empirical findings on consumers' intention to practice safe eating out measures during COVID-19.

Undergraduate medical students\u2019 attitudes towards medical errors and patient safety: a multi-center cross-sectional study in the Gaza Strip, Palestine

BackgroundIn undergraduate medical education, patient safety concepts and understanding of medical errors are under-represented. This problem is more evident in low-income settings. The aim of this study was to explore undergraduate medical students’ attitudes towards patient safety in the low-income setting of the Gaza Strip.MethodsA cross-sectional, descriptive study included medical students of the two medical schools in the Gaza Strip with 338 medical students completing the Attitudes to Patient Safety Questionnaire-IV (APSQ-IV), which examines patient attitudes in 29 items over 10 domains. Results are represented as means ± standard deviations for each item and domain as well as percentage of positive responses to specific items.ResultsMedical students reported slightly positive patient safety attitudes (4.7 ± 0.5 of 7) with the most positive attitudes in the domains of situational awareness, importance of patient safety in the curriculum, error inevitability and team functioning. While no negative attitudes were reported, neutral attitudes were found in the domains of professional incompetence as a cause of error and error reporting confidence. Study year and gender had no significant association with patient safety attitudes, except for disclosure responsibility, where male students displayed significantly more positive attitudes. The study university was significantly associated with three of the 10 examined domains, all of which involved understanding of medical errors, for which students of University 2 (who had undergone limited patient safety training) held significantly more positive attitudes, compared with students of University 1 (who did not have structured patient safety training).ConclusionMedical students’ patient safety attitudes were very similar among students from both universities, except for understanding of medical error, for which students, who had received structured training in this topic, displayed significantly more positive attitudes. This underlines the power of the ‘hidden curriculum’, where students adjust to prevalent cultures in local hospitals, while they do their clinical training. Furthermore, it highlights the need for a systematic inclusion of patient safety content in local undergraduate curricula.

Treating patients in a safe environment: a cross-sectional study of patient safety attitudes among doctors in the Gaza Strip, Palestine

BackgroundPatient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes.MethodsDoctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace.ResultsA total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain “Working hours as a cause of errors” (4.16) and the lowest score by “Importance of Patient Safety in the Curriculum” (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety.ConclusionDoctors in Gaza demonstrated relatively positive patient safety attitudes in areas of “team functioning” and “working hours as a cause for error”, but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.

Nursing safety attitudes: relationship with time of experience and intention to leave the job.

To evaluate the safety attitudes of the nursing staff and their relationship with staff adequacy and material resources, time of experience and intention to leave the job. A descriptive and cross-sectional study in a teaching hospital, sampled by convenience, with the application of the Safety Attitudes Questionnaire, collected from January to April 2016. 262 professionals participated, of whom 98 were nurses and 164 technicians. They reported a positive safety attitude for job satisfaction. The adequacy of staff and material resources positively influenced safety attitudes. There was a negative correlation between time of experience and perception of management, safety climate, working conditions and safe behaviors and, between the intention to leave the job and the teamwork climate, job satisfaction, and safe behaviors. The negative perception of safety attitudes was related to the time of experience and to the intention to leave the job.

Integrating Safety Attitudes and Safety Stressors into Safety Climate and Safety Behavior Relations: The Case of Healthcare Professionals in Abu Dhabi.

ObjectivesHow safety climates, safety attitudes, and safety behaviors are related remains unexplored in the literature, with no study so far investigating the moderating path of safety stressors between these variables. We sought to understand the path through which safety climates may affect safety-behavior-related outcomes, such as safety compliance and participation, through the integration of safety attitudes. Since this study is related to the safety-related perception-intention-behavior relationship, safety stressors are proposed as a moderator of this relationship.MethodsA total of 770 healthcare professionals working in public hospitals across Abu Dhabi were randomly selected for this study. We used questionnaires covering demographic details, safety behaviors, safety climates, safety attitudes, and safety stressors to obtain the data.ResultsThe results revealed the partial mediating role of safety attitudes in the relationship between safety climate and safety behavior. Additionally, safety stressors did not moderate the relationship between safety climates, safety attitudes, and safety behaviors, which has some interesting implications for healthcare professionals.ConclusionsThe study suggests that safety attitudes may also regulate the impact of perceptions of management values regarding safety, policies, and procedures. It is highly likely that healthcare professionals who experience a positive workplace safety climate will form positive safety attitudes that encourage safety behavior. In addition, the homogeneous characteristics of healthcare professionals’ in the UAE may also offer the positive coping strategy that caused the insignificant moderating effect of safety stressors on the relationship between safety climates, safety attitudes, and safety behaviors.

The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling.

Every year, studies about food handlers' food safety knowledge, attitudes, and practices are published. Some results of these papers have been rather controversial, especially those related to food safety practices. The two most common methods for evaluating food safety practices - self-assessment and observation - are generally treated as interchangeable, but they can have different meanings. The objective of this study was, therefore, to differentiate between the observed and self-reported food safety practices of food handlers, verifying the effect of different variables in these food safety indicators through structural equation modeling, and examining the relationship between cognitive factors and these practices. A questionnaire with 37 questions was given to 183 food handlers to evaluate their food safety knowledge, attitudes, self-reported practices, and risk perceptions. For the observed assessment method of evaluating the food handlers' practices (observed practices), a checklist was developed, and food handlers were observed during one workday. Two models were developed based on the results of these two assessment methods. In the first model a significant positive effect of knowledge and a negative effect of risk perception on self-reported practices were observed. Food handlers with high risk-perception about their practices reported less adequate practices. Positive food safety attitudes acted as a moderator dampening the positive effect between knowledge and self-reported practices. In the second model a significant positive effect of knowledge on observed practices. Attitudes strengthened the positive effect between knowledge and observed practices. On the other hand, a direct effect of attitude on observed practices was not observed. In conclusion, self-reported practices and observed practices are different and should be used and discussed properly.

Safety attitudes in hospital emergency departments: a systematic review

PurposeThe purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs).Design/methodology/approachAn electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs.FindingsOverall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs.Research limitations/implicationsSix studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality.Originality/valueTeamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the “front-line” of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.