Structural Factors Determine Patient Safety in Taiwanese Nursing Units: Mechanistic Versus Organic Structure

Wednesday, 24 July 2013

Chang-Chiao Hung, PhD
Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan

Learning Objective 1: The learner will be able to know the effects of structural factors on patient safety

Learning Objective 2: The learner will be able to get directions in developing a nursing practice structure

Purpose: Patient safety has long been identified as a major issue for healthcare organizations globally. Only a few studies have been conducted to explore the effects of nursing unit structure on patient safety. The purpose of this study therefore was designed to determine the effects of structural factors on patient safety in Taiwanese nursing units.

Methods: The study framework derived from the concept of structural contingency theory. A cross-sectional design was used and data were collected through self-administered questionnaires using Dillman’s Tailored Design Method. A total of 1,364 participants who worked in 64 surgical and medical units were invited. Data aggregation included Eta-squared coefficient, inter-item consistency, and F ration were used to aggregate data from the individual to the unit level. Multiple regression was used for data analysis.

Results: A total of 1,039 participants (76.7%) completed and returned the questionnaire. Eta-squared coefficient (h2), inter-item consistency (rwg), and F ratio showed that data at the individual level were appropriate to aggregate to the unit level. Results shown that the medication error rate was higher on units with a high degree of professional autonomy (b =.59; p < .05) and participation in decision making (b =.25; p < .05). Similarly, the nursing units with a high degree of participation in decision making would have high rates of patient fall (b =.25; p < .05).

Conclusion: This study provides support for the use of structural approaches to examine patient safety issues, and also provide some directions for head nurses in developing a nursing practice structure.