Discussion
Diversity and quality elements in health service presentation are prioritized as the health services improve and patients learn about their rights. Patient safety is one of the most important issues among these. Patient safety, in general sense, is the precautions taken by the institution and workers at the phase of healthcare services presentation in order to prevent the patient from getting harm. Complicated nature of health care presentation might harm patients while they receive services and could affect the formation of patient safety culture negatively. Health care providers are aware of the fact that several cases that are reflected on patients are experienced almost every day. These events should not be ignored; they should be recorded, measured, analyzed, and improved. 18-20 The present study found that the existing practices and working conditions did not provide workers’ comfort at good level; and this case was found to affect patient safety attitudes and practices.
Patient safety has become an irreplaceable component due to a number of factors such as increase in the consciousness level, expectations, and demand for health services in Turkey; technological developments and the risks they create; increased cost of services and the burden it causes in social security system; increase in the service quality standards; increasing competition; legal responsibilities; and constantly improving health policies. 21 A study on patient safety conducted by Karaca and Arslan (2014: 14), which involved two private hospital workers, reported no significant differences between gender and marital status and patient safety in one hospital; but such difference was found in the other hospital. 22 As for the present study, I found no significant differences between the workers’ gender and marital status according to their patient safety attitudes mean scores. Gender and marital status are not major variables that affect patient safety attitudes, which indicates why there is lack of significant difference between patient safety attitudes mean scores. Rızalar et al. (2016: 9) reported that nurses’ receiving education on patient safety, departments where they worked, duration of working in this profession, and type of duty significantly affected patient safety culture levels. 23 A study conducted in Iran with 302 nurses working in university hospitals24 and a study conducted in China with 463 nurses reported that the nurses’ perceptions of patient safety culture were not at desired levels.25
In their study which evaluated safety attitudes of operating room nurses and surgeons, Prati and Pietrantoni (2013: 669) found a statistically significant difference between the occupation groups.26 A comparison of the participants’ safety attitudes according to the occupation groups indicated a statistically significant difference between the groups’ mean scores in the present study. Particularly the surgeons’ significantly higher safety attitudes scale mean scores could result from a number of factors including being more knowledgeable about patient safety and having more responsibilities.
Working in shifts, working in changing times at daytime and nights have negative effects on nurses’ biological rhythm, inner physiological clock, and balance; a tired, sleepless nurse’s work affects patient care and safety. Long working hours is a factor that affects workers’ working performance and threatens worker and patient safety.27-29 In the study conducted with 393 nurses in the USA, Rogers (2004: 202) reported that nurses working for more than 12 hours a day and more than 40 hours a week tended to make more mistakes and could risk patient safety. 30 According to the results of a study that investigated 31.627 registered nurses in general medical/surgical units of 488 hospitals in 12 European Countries, lower quality and safety and more care left undone were reported among European registered nurses working shifts of ≥12 hours and those working overtime. A 12-hour nursing shift pattern is an issue that should be approached with caution. Further risks to quality would be caused with the use of overtime working to mitigate staffing shortages or increase flexibility .31The present study found that patient safety attitudes mean scores of those who had both night and daytime shift were found to be significantly higher than those who worked only daytime.
Orientation training, which is complicated especially in terms of the technical equipment used and processes, is highly important in enhancing work adaptation of those who work in units that require special knowledge and skills. One of these units are operating rooms.32-35 Van Beuzekom et al. (2013: 112) reported that lack of training and experience is the source of medical errors.35 Patient safety attitudes mean scores of the health professionals participating in this study were found to be significantly different according to participation in orientation programs and trainings on patient safety. Patient safety attitudes score of those who participated in the orientation program and received training on patient safety were found to be significantly higher.
Despite the fact that the health personnel participating in this study defined the communication with team members and quality of cooperation as “adequate” at various levels, it is considered that communication and Teamwork Climate quality should be improved more. In the perioperative care, where worker and patient traffic is very high and where it is compulsory to work with technological tools and devices that require special knowledge and skills, it is highly important to ensure patient safety at optimum levels and enhance workers’ job satisfaction and safety. An analysis of the Safety Attitudes Questionnaire (SAQ-OR) mean scores in this study showed that stress recognition mean score was the lowest, and that of safety climate was the highest. Although workload and work tempo are very high in perioperative care, workers’ job satisfaction levels are considered to be high due to the nature of the job done. Development of a common attitude towards patient safety culture seems to be impossible without improving workers’ working conditions. Health workers that have roles in perioperative care (surgeon, anesthetist, operating room nurse, etc.) should develop a behavior style about patient safety practices as a whole team, and general standards of the institution should be identified and followed clearly so that a homogenous structure could be formed about patient safety. Despite this, particularly safe surgical practices should be followed carefully, necessary interventions should be planned in order to meet the identified requirements, and education programs should be organized. Workers should be encouraged about error reporting; their worries and fears about this issue should be eliminated.36
The limitation of this study is that it was conducted in one hospital and with a small group of participants. Such study should be carried out in hospitals with various systems and in larger groups. This way, it would be possible to raise awareness of the institutions and workers about patient safety, which is a neglected issue.