Patient Safety Culture, Compassion Fatigue, Compassion Satisfaction: Impact on Nurse-Sensitive Patient Outcomes

Purpose:

The Institute of Medicine (IOM) defines patient safety as “freedom from accidental injury and ensuring patient safety involves establishing operational systems and processes that minimize the possibility of errors and maximize the possibility of intercepting them when they occur”. For over a decade healthcare organizations have placed a great deal of effort into establishing operational systems and processes to minimize errors and achieve a culture of safety in their organization. This effort to improve patient safety has been one of the most highly publicized and critical issues facing the healthcare industry. In 1999 the IOM report To Err Is Human stated that avoidable medical errors annually contributed to 44,000 to 98,000 deaths in the United States. Current estimates now place the number to between 210,000 and 440,000 patients annually.

Since the IOM report, there has been a diverse level of engagement to improve health care safety. Although improvements have been made, health care safety is still not demonstrably and measurably safer due to the complexity of the healthcare system and the challenge of creating cultures of safety which requires changes in behaviors. Nursing literature shows a plethora of research on the relationship between safety culture and patient outcomes with overall results demonstrating that better safety culture is related to better outcomes. Also, in terms of compassion fatigue much of the nursing research focus has been on the risks, prevalence, and causes; with a focus on burnout and very little research conducted on the outcomes of compassion fatigue on the patients. To date, the interrelated relationship between nursing units’ safety culture and compassion fatigue constructs have not been examined in relations to patient outcomes.

The study aims were: To examine the relationships between: a) inpatient nursing units’ patient safety culture, b) nurse compassion fatigue, c) nurse compassion satisfaction, and d) the impact on nurse-sensitive patient outcomes.  Bronfenbrenner’s bioecological model guided this study.

 Methods: This was a quantitative descriptive correlational design, which used primary and secondary data. Primary data on patient safety culture, compassion fatigue, and compassion satisfaction were collected through a convenience sampling of registered nurses (N = 127), employed on inpatient units of a teaching hospital in South Florida, who responded to a self-administered anonymous Qualtrics electronic survey delivered by email. Secondary administrative 2013 NDNQI data was provided by the hospital for unit nurse-sensitive patient outcomes. The dependent variables to address the research questions were unit rates for falls, falls with injury, hospital acquired decubitus ulcers, catheter associated urinary tract infections, and central line associated blood stream infections. As a result, statistical models were generated for each of the five dependent variables. The independent variables were the units’ patient safety culture as measured by overall patient safety perception and patient safety grade, compassion fatigue, and compassion satisfaction. Pearson’s correlations, three-way ANOVA, and multiple regression statistical analyses were used to analyze the data.

 Results: Of the total participants, the two components of compassion fatigue, burnout (BO) and secondary traumatic stress (STS), were present, with 29.1% of the nurses were at risk for BO, and 19.7% of the nurses were at risk for STS. Significant correlations were found between patient safety culture, compassion fatigue, and compassion satisfaction. Initial overall regression models did not predict nurse-sensitive patient outcomes. However, inclusion of demographic variables, covariates, and additional patient safety culture variables did explain variances in the sample. The study significant findings seem to cluster around unit type, nurse characteristics, and elements of patient safety culture.

 Conclusion: This study was a unique exploration of patient safety culture, compassion fatigue, and compassion Satisfaction on nurse-sensitive patient outcomes. The study results demonstrates the need for further nursing research to better understand patient safety culture, compassion fatigue, and compassion satisfaction which would lead to development of effective strategies to improve patient safety outcomes.