Learning Objective #1: Discuss individual and organizational factors associated with the creation and maintenance of a safety culture in acute care hospital settings

Learning Objective #2: Describe relationships among nurses' motivational and cognitive styles and perceptions of safety culture, as related to nurses' reported medication errors

---

Promoting a strong safety culture in health care is a mainstay of the patient safety movement to support high quality care and optimal patient safety outcomes. The IOM has recommended research in the areas of interpersonal behaviors and interactions that influence cognitive decision-making & behavioral skills that support patient safety and error prevention. What are the relationships between and among nurses' intra-personal behavioral motivation, cognitive decision-making styles, safety culture, and medication errors? Safety culture is defined as “…the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine commitment to, and the style and proficiency of, an organization's health and safety management” (HSC, 1993, p. 23). This research documents relationships among hospital safety culture, individual nurses' motivational and cognitive styles, in relation to nurses' reported medication errors.

Method: A cross-sectional, correlational pilot study of 158/186 non-agency staff registered nurses were surveyed (85% response rate), involving six medical/surgical nursing units with turnover rates of < 7%, served by same medical staff in two urban hospitals in one metropolitan healthcare system. Nurses were surveyed on motivational and cognitive styles, and perceptions of unit and hospital safety culture. Retrospective data were collected on nurses' reported medication administration errors for six contiguous months from onset of study.

Results: Results indicate significant correlation between nurses' cognitive decision-making style, motivational inhibition, and motivational drive. Higher levels of motivational inhibition were found to be associated with lower levels of med error reporting and problems with hospital "hand offs" between nursing units. Numerous aspects of nurses' perceptions of hospital safety culture are associated with nurses' med error reporting.

Conclusion: This study contributes data and evidence that helps explain the role of individual and system contributions to safety in health care contexts. Implications for future research will be discussed.