الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Patient safety practices are crucial toward improving overall performance and quality of services in healthcare organizations. The main factors that influences patient safety in medical industry is the culture of patient safety. It reflects the essence of organizations. Also, it is able to reveal the strengths and weaknesses that constitute the way that healthcare specialists practice to perform their work. Governments, health‐care decision‐makers and health professional associations have identified nurse –physician collaboration as an important policy approach for addressing patient safety issues and transforming the health‐care system. Also, empowerment is described as one of the key practices, playing a fundamental role in professional practice environments for nurses.
Aim of the study
The study aims to identify the relationship between empowerment, collaboration, and patient safety culture in surgical units.
Setting of the study:
The study was conducted in all surgical inpatient care units and its specialists in Alexandria Main University Hospital. The capacity of all surgical units is 750 beds.
The surgical units (N=15) included in the study are: head and neck, cardiothorax,spinalsurgery,vascular,hepatic,neurosurgery,plastic,otorhinolaryngology, gastrointestinal tract, ophthalmology, colon and rectum, oncology, pediatric surgery, urology (male and female), children urology.
Subjects of the study
1. The study subjects were all nurses (250 nurses) who were working in the previously mentioned units, with at least one year experience and who will be available during time of data collection.
2. All resident physicians (80 physicians) who were working in the previously mentioned units, with at least one year experience and who will be available during time of data collection.
Tools of the study:
Three tools were be used to conduct this study:
Tool (1) Hospital Survey on Patient Safety Culture (HSOPS):
It was developed by Agency for Healthcare Research and Quality (AHRQ) in (2004) and revised by Agency for Healthcare Research and Quality (AHRQ) in (2016). It was adopted and used to assess patient safety culture in specific units within a hospital. It consists of 42 items, measuring 12 dimensions of patient safety culture, and two outcome variables.
The safety culture dimensions are divided into: seven dimensions at unit-level (24 item), namely: manager promoting safety (4items), organizational learning (3items), teamwork within hospital units (4items), communication openness (3items), feedback and communication (3items), non-punitive response to error (3items) and staffing (4items). Hospital- wide level aspects of safety culture measuring three dimensions namely : hospital management support (3items), teamwork across hospital units (4items) and hospital handoffs & transitions (4items).The two dimensions for outcome variables are frequency of event reporting (3items) and overall perceptions of safety (4items) and other two single-items measuring numeric response categorized as outcome variables including: patient safety grade (1 item) and number of events reported (1 item).
A collective response of a 5-point Likert scale, depending on the question asked; the scale represents 1 (strongly disagree) to 5 (strongly agree) or 1 (never) to 5(always) were used. Reversed score was applied for negative worded items. The scoring system was ranged from (42-210).Positive perception of patient safety culture score (127-210) and negative perception of patient safety culture score (42-126).
Tool (2): Nurse-Physician collaboration scale (The NPCS)
It was developed by Ushiro et al. (2009) and adopted by the researcher. It measures the actual collaborative behavior between nurse and physician .NPCS consists of three main dimensions with 27 items namely: joint participation in the care / cure decision – making process (12 items); the sharing of the clinical patient information (9 items); the nurse physician cooperation (6 items).
Responses were measured on a five point likert scale ranging from (1) strongly disagree to (5) strongly agree. There was no reverse scoring on the tool. The overall score ranging from (27 to 135).High nurse –physician collaboration score (81-135), Low nurse –physician collaboration score (27- 80).
Tool (3) Conditions for Work Effectiveness Questionnaire- II (CWEQ-II):
It was developed by Laschinger et al. (2001) and revised by Laschinger et al. (2013). The CWEQ-II is a modification of the original conditions of work effectiveness questionnaire (Chandler, 1986) to measure structural empowerment, it was adopted .It consists of 19 items divided into six dimensions include opportunity (3items), information (3items), support (3items), resources (3items), formal power (3items), and informal power (4items).
The response was measured on a 5 point Likert scale ranging from 1 (none, no knowledge, or strongly disagree) to 5 (a lot, know a lot or strongly agree). A total empowerment score by summing the CWEQ-II six subscales. The scoring system was ranged from (19-95).High structure empowerment score (58-95) and low structure empowerment score (19-57).
In addition to demographic& work related data:
It was designed by the researcher and used to describe the sample. The variables to be collected including: age, gender, level of education, work schedule shift, identification of their surgical specialty, and years of work experience.
Method
• An official permission was obtained from the Faculty of Nursing and the administrators of the identified settings to collect the necessary data.
• The tools translated into Arabic and tested for content validity as the content validity of the collaboration tool (NPCS) was tested by Mohamed (2017) the empowerment tool (CWEQ-II) was tested by Saleh (2014), and the content validity of the patient safety culture tool (HSOPS) was tested by Elzohairy (2014) and was used.
• The reliability of the empowerment tool (CWEQ-II) by Cronbach’s Alpha Coefficient was (0.907), the collaboration tool (NPCS) by Cronbach’s Alpha Coefficient was (0.955) and the patient safety culture tool (HSOPS) by Cronbach’s Alpha Coefficient was (0.722).
• A pilot study was carried out on 10% of nurses (n= 25) and physicians (n=8) that were not be included in the study subjects in order to check and ensure the clarity of tools, identify obstacles and problems that may be encountered during data collection and no modifications were done.
Data collection
• Data collection for this study was conducted by the researcher through self –reported questionnaires where the three tools were hand delivered to nurses while the nurse –physician collaboration scale was delivered only to physicians after meeting with each nurse and physician for about 5 minutes to explain the aim of this study and the needed instructions were given before distribution of the questionnaire in their work setting. Completion of the questionnaire took approximately (5-10 minutes) for physicians and (20-30 minutes) for nurses. the data collected in a period of about 2 months from 7-2-2018 to 15-4-2018.
The following were the main results of the present study:
• There was a highly positive statistical significant correlation between empowerment, nurse –physician collaboration and patient safety culture.
• Nurses perceived moderate structural empowerment, collaboration and patient safety culture as represented in its all dimension.
• There was statistical significant difference between demographic characteristics of nurses and overall structural empowerment in terms of working shift and gender.
• Nurses and resident physicians perceived moderate nurse-physician collaboration, as represented in its all dimensions.
• There was a statistical significant difference between nurses & resident physician perception of collaborative behavior. Also, it can be seen that resident physicians perceived moderate nurse collaborative behavior higher than nurses.
• There was no statistical significant difference between demographic characteristics of resident physicians and overall nurse-physician collaboration except in the terms of physicians’ educational qualification.
• There was a highly statistical significant difference between demographic characteristics of nurses and overall nurse-physician collaboration in the term of nurses’ years of experience in nursing profession.
• Nurses perceived neutral patient safety culture, as represented in its all dimensions
• There was a statistical significant difference between overall patient safety culture and demographic characteristics of nurses in the terms of specialty surgical unit, working shift, years of experience in nursing profession, gender.
Recommendations were given focused on the results of the present study to improve patient safety culture, structural empowerment and nurse-physician collaboration through increasing the availability of training programs, education and enhance positive work environment for nurses and physicians to build their collaboration. Enhance empowerment by providing opportunity for support, access to resources, information and necessary power to accomplish work. To improve patient safety culture by introducing reporting system to be available without fear of punishment, no blame culture for holding nurses accountable for patient safety issues.