SAFETY CULTURE IN OBSTETRIC NURSES' CLINICAL PRACTICE

an observational, analytical and cross-sectional study, carried out from September 2018 to May 2019 at two maternity hospitals integrated in a hospital center in the Central region of Portugal. A total of 70 obstetric nurses answered the Hospital Survey on Patient Safety Culture. The data were submitted to descriptive and inferential analysis. The dimensions were considered strong when they presented scores ≥ 75.0% of positive answers, and deemed as problematic with scores ≤ 50.0%.

Results:

the “Teamwork within units” dimension was the one that obtained scores above 75.0%. The “Supervisor expectations”, “Feedback and communication about errors”, “Communication openness”, “Organizational learning” and “Hospital handoffs and transitions” dimensions obtained scores between 50.0% and 65.0%. The “Non-punitive response to error”, “Frequency of events reported”, “Management support for patient safety” and “Staffing” dimensions had scores below 40.0%.

Conclusion:

the results of this study show that “Teamwork within units” is a strong safety culture dimension in maternity hospitals. However, the prevalence of a punitive culture, underreporting of adverse events, insufficient number of obstetrical nurses and little commitment of the hospital management are considered as problematic dimensions that influence obstetric nurses' practice. This assessment of the safety culture contributes to planning interventions that reduce the incidence of errors and improve the safety of obstetric care.

DESCRIPTORS:
Obstetric Nursing; Patient safety; Safety management; Organizational culture.

Variables	Mean	Standard Deviation
Variables	n	(%)
Age (years old)	45.5	9.0
Professional experience in the current institution (years)	19.58	8.9
Gender
Female	63	90.0
Male	7	10.0
Marital status
Single	15	21.4
Married/De facto union	43	61.5
Divorced	8	11.4
Widowed	4	5.7
Academic qualifications
Bachelor's degree	1	1.4
Graduation degree	50	71.4
Master's degree	19	27.1
Professional experience
<20 years	33	47.1
>20 years	37	52.9
Professional experience in the current institution
<20 years	39	57.7
>20 years	31	44.3
Training in patient safety
Yes	5	7.1
No	65	92.9

Safety culture dimensions	No. of items	Mean % of positive answers
In the context of the unit
Teamwork within units	4	78.2
Supervisor/Manager expectations and actions promoting patient safety	4	63.6
Organizational learning - Continuous improvement	3	51.9
Feedback and communication about errors	3	60.0
Communication openness	3	60.5
Staffing	4	35.7
Non-punitive response to error	3	19.5
In the hospital context
Management support for patient safety	3	21.0
Teamwork across units	4	40.4
Hospital handoffs and transitions	4	57.8
Safety culture outcome variables
Overall perception of patient safety	4	44.8
Frequency of events reported	3	21.0

Variables	n	(%)
Patient safety level
Very weak	1	1.4
Weak	16	22.9
Acceptable	28	40.0
Very good	24	34.3
Excellent	1	1.4
Number of events reported
None	60	85.7
From 1 to 2 event reports	9	12.9
From 3 to 5 event reports	1	1.4

Variable	Professional experience (n=70)					Training in patient safety (n=70)
	<20 years (n=33)		>20 years (n=37)		p-value^*	No (n=65)		Yes (n=5)		p-value^†
	Median	95% CI^†	Median	95% CI^†		Median	95% CI^†	Median	95% CI^†
Dim. 1^‡	4.00	4.00;4.25	4.00	4.00;4.25	0.525	4.00	4.00;4.25	3.75	3.25;4.25	0.478
Dim. 2^§	3.75	3.75;4.00	3.50	3.25;4.00	0.371	3.75	3.75;4.00	3.25	3.00;4.00	0.247
Dim. 3^\|\|	3.33	3.00;4.00	3.67	3.67;4.00	0.380	3.33	3.33;3.67	3.00	3.00; 4.00	0.492
Dim. 4^¶	2.33	2.00;3.00	3.00	3.00;3.33	0.078	2.67	2.67;3.33	3.00	3.00;3.67	0.241
Dim. 5^**	3.00	2.75;3.75	3.00	2.75;3.50	0.493	3.00	2.75;3.50	2.75	2.25;3.75	0.801
Dim. 6^††	3.33	3.33;3.67	3.67	3.67;4.00	0.971	3.67	3.67;4.00	3.33	3.00;4.00	0.528
Dim. 7^‡‡	3.67	3.33;4.00	3.33	3.33;3.67	0.853	3.67	3.67;4.00	3.00	3.00;4.00	0.207
Dim. 8^§§	2.00	2.00;3.00	2.67	2.00;3.33	0.115	2.00	2.00;3.00	2.67	2.00;4.33	0.634
Dim. 9^\|\|\|\|	3.25	3.25;4.00	3.25	3.25;3.75	0.201	3.25	3.25;3.75	3.25	3.00;4.00	0.604
Dim. 10^¶¶	2.75	2.50;3.25	3.00	3.00;3.50	0.317	3.00	3.00;3.25	2.75	2.25;3.00	0.172
Dim. 11^***	3.50	3.50;4.00	3.50	3.25;4.00	0.428	3.50	3.50;4.00	3.25	3.00;4.25	0.835
Dim. 12^†††	2.33	2.33;3.00	2.67	2.67;3.33	0.571	2.67	2.67;3.00	2.33	2.33;3.00	0.540

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Cláudia Patrícia da Costa Brás claudiabras@esenfc.pt