Opening the ‘black box’ of patient safety: the impact of the nursing work environment, job and individual characteristics

The nursing work environment is a recognised aspect of complex healthcare delivery where patient safety improvements should be focused (Lin & Liang, 2007). This thesis explored the many factors that come to influence safety perceptions within hospital nursing. The main aims of the work were to 1) understand how work environment factors are associated with safety perceptions, 2) understand how job characteristics are associated with safety perceptions, and 3) explore the role of individual characteristics (e.g., personality) in terms of both direct associations with safety perceptions, but also how work environment and job characteristic associations with safety perceptions might differ dependent upon individual characteristics. A multi-method approach was taken to address these main objectives, and a systematic review of the literature was conducted. Study one used semi-structured interviews to understand patient safety incident contributory factors from the health professional perspective. Studies two and three were then developed based on the systematic review and interview findings. Study two employed a cross-sectional design and gathered data on work environment factors, job characteristics, individual characteristics and safety perceptions in relation to the previous 12 months, and highlighted important associations between these variables. Study three employed a within-person design, in the form of an end of shift daily diary. Nurses were assessed on background individual and job characteristics, and provided information on work environment factors, hassles, mood and safety perceptions over a three-to-five shift period. The data generated was assessed using multilevel modelling techniques, and illustrated associations between daily predictors and safety perceptions, and added further support for the important role of individual characteristics. Specifically, conscientiousness was directly associated with daily safety perceptions, as well as a moderator of daily associations. With regards to job characteristics, support was an important moderator or ―buffer‖ of daily associations. The thesis also considers the implications of the research and avenues for future work, as well as limitations and the challenges of undertaking applied research in such a sensitive area.