Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.

INTRODUCTION: Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach. DESIGN: Cross-sectional design complying with STROBE guidelines. METHODS: Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis. RESULTS: Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance. CONCLUSIONS: The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance. CLINICAL RELEVANCE: Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice. PATIENT OR PUBLIC CONTRIBUTION: This study had no patient contribution or public funding.

The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate.

PURPOSE: This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors. DESIGN: This study incorporates a cross-sectional research design. METHODS: The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis. FINDINGS: The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors. CONCLUSIONS: Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling.

AIMS: The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs). BACKGROUND: Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines. DESIGN: Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines. METHODS: Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis. RESULTS: The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs. CONCLUSIONS: Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance. IMPLICATIONS FOR NURSING POLICY AND PRACTICE: Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities.

BACKGROUND: Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda. METHODS: A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisational-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country. RESULTS: Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (ß = 0.56, p < 0.001), supportive supervision (ß = 0.34, p < 0.001), and district managerial support (ß = 0.29, p < 0.001). In Ghana, safety climate was positively associated with job satisfaction (ß = 0.30, p < 0.05), teamwork (ß = 0.46, p < 0.001), and supportive supervision (ß = 0.21, p < 0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (ß = 0.56, p < 0.001), supportive supervision (ß = 0.43, p < 0.001), and perceived district managerial support (ß = 0.35, p < 0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (ß = 0.39, p = 0.005) and supportive supervision (ß = 0.27, p = 0.023) significantly and positively associated with safety climate. DISCUSSION/CONCLUSIONS: Our findings highlight the importance of unit-level factors-and in specific, teamwork and supportive supervision-as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.

Safety climate and readiness for implementation of evidence and person centered practice - A national study of registered nurses in general surgical care at Swedish university hospitals.

BACKGROUND: The rationale behind this study is the increasing research on relationships between patient safety, evidence based practice and person centered care, and the growing interest in outcomes of surgical patients. The aim of this study was to explore the safety climate and readiness to implement evidence-based and person centered care as perceived by registered nurses in Swedish surgical care. METHODS: The design was an exploratory, cross-sectional survey carried out in a national Swedish context. Data were collected through the Safety Attitudes Questionnaire (SAQ - Short form) and the Context Assessment Index (CAI). RESULTS: In total, 1570 questionnaires were distributed, of which 727 were returned, giving a response rate of 46.3 %. The results revealed that in general, the safety climate in Swedish surgical care is positively related to readiness for evidence-based and person centered care, although specific management and cultural factors may be more sensitive and represent targets for improvement. CONCLUSION: This study presents new knowledge regarding the safety climate and readiness to implement evidence based practice and person centered care in general surgical wards in university hospitals and indicates important associations between these two areas. While RNs generally reported positive job satisfaction and a good team work culture in their units, there were indications that improvements in organizational management are needed.

Rethinking frontline health workers' safety performance in times of pandemic: the role of spiritual leadership.

This study examined the impact of spiritual leadership style on frontline health workers' safety performance through the mediating role of safety climate. Also, leader-member exchange (LMX) was examined as a moderator of the safety climate and safety performance relationship. Survey data from 582 frontline health workers in Ghana's Greater Accra and Ashanti regions were analyzed using AMOS version 23. Findings showed that spiritual leadership dimensions significantly influenced health workers' safety performance. Altruistic love and vision also significantly influenced safety climate. However, hope did not influenced safety climate. Moreover, safety climate had an impact onsafety performance dimensions. Furthermore, safety climate mediated the relationship between altruistic love, vision, and safety performance. However, safety climate did not mediate the relationship between hope and safety performance. Lastly, LMX moderated the positive effect of safety climate on safety compliance but not on safety participation. This study offers valuable insights for improving frontline health workers' safety performance during pandemics.

Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists' Clinical Supervision and Nurse Anesthetists' Work Habits.

INTRODUCTION: Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined. METHODS: Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day. RESULTS: There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen's d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day's count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important. CONCLUSIONS: When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision quality and work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians' non-technical performance.

Exploration of COVID-19 Pandemic Prevention Behaviors among Healthcare Workers.

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers' health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers' pandemic prevention behaviors as a reference for medical facility administrators in real practice.

The Moderating Effects of Social Responsibility Climate and Safety Climate in Keeping Healthcare Workers' Engagement during COVID-19.

OBJECTIVE: The outbreak of COVID-19 brings an overload of physical and mental demands to healthcare professionals. Keeping healthcare professionals sustainable, engaged, and performing at their highest levels becomes critical and nonetheless difficult. The objective of this research is to link the literature on organizational climates, corporate social responsibility, safety science, and work engagement, and propose a research framework that investigates the factors influencing healthcare professionals' engagement during COVID-19. METHODOLOGY: We propose that when healthcare workers' career callings are triggered by COVID-19, it influences their perceptions of the work's meaningfulness, which ultimately enhances their work engagement. We argue that creating a social responsibility climate and a safety climate inside the hospital facilitates the process of turning healthcare workers' perceived work meaningfulness into work engagement. We collected data from 112 healthcare professionals, including nurses, doctors, and executive staff, from 16 wards in a public hospital in China to test our hypotheses. RESULTS: Hierarchical linear regression analysis provided empirical support for our research model. We find that healthcare professionals' career callings during COVID-19 enhanced their perceived work meaningfulness, which results in increased work engagement. Moreover, a social responsibility climate and a safety climate strengthens the link between work meaningfulness and work engagement among participants. CONCLUSIONS: Creating a social responsibility climate and a safety climate in the workplace are effective management approaches to realize healthcare workers' feelings of work meaningfulness and turn them into work engagement.

Examining the Impact of Elastomeric Half Mask Respirator Knowledge and User Barriers on Safety Climate Perceptions in Health Care Settings.

BACKGROUND: Availability of personal protective equipment (PPE) and its effective use may influence safety climate perceptions among health care personnel (HCP). It is unclear how health care organizations can leverage the effective use of respiratory protection to engage in continuous improvement of their safety climate, which can inform opportunities for employee education and engagement. METHODS: After using an elastomeric half mask respirator (EHMR) as their primary form of respiratory protection for several months, 1,080 HCP provided feedback in an electronic survey about respiratory protection training, confidence in EHMR use, barriers during use, and perceived safety climate. Ordinal logistic regressions were used as nonlinear models to test relationships between these variables. FINDINGS: We observed that an increase in user confidence (p < .013), training content (p < .001), training formats (p < .001), and a decrease in EHMR barriers (p < .001) were associated with a statistically significant increase in proactive safety climate. In the second model, an increase in user confidence (p < .006) and training content (p < .001), and a decrease in barriers (p < .001), was associated with a statistically significant increase in compliant safety climate. CONCLUSIONS/APPLICATION TO PRACTICE: HCP EHMR confidence was positively associated with safety climate perceptions, underscoring the value of competency building by respiratory protection leaders prior to implementation. Because fewer barriers experienced while using an EHMR were associated with a more positive perception of safety climate, it is important to first communicate with end users about potential barriers and, second, to continue research with end users and manufacturers to improve the design of EHMRs moving forward.

Safety perception in the operating environment: The nurses' perspective versus that of the surgeons.

Background: Adverse effects due to surgery occur in 25% of patients, and the patient safety perception seems to differ between nurses and surgeons in the operating room (OR). This difference can be attributed to lack of communication. However, our hospital has not conducted any studies on patient safety climate (PSC) in the OR. Aims: To determine if the perception of PSC of nurses and surgeons in the OR diverges and understand whether these differences could be explained by communication gap. Methods: A total of 42 perioperative nurses and 44 surgeons in the OR of a tertiary hospital answered the Spanish version of the US Hospital Survey on PSC. This was an observational, cross-sectional study with descriptive statistics and a non-parametric test. Results: Nurses had a worse perception of the dimensions of overall safety, leader expectations, teamwork within units, feedback, staffing, and hospital management (p < .05). Although no differences were found concerning organizational learning/continuous improvement, communication openness, nonpunitive responses, and teamwork across hospital unit dimensions, the findings suggest that the nurses' perception was worse than that of the surgeons. Conclusions: In general, OR nurses have worse PSC than surgeons, mainly in the areas where communication it's important. Our study has provided the data that will enable the hospital management team to make decisions to improve the PSC in the operating room area. We recommend a more active presence of nurses in directive teams.

Turnover intention among operating room nurses during the COVID-19 outbreak and its association with perceived safety climate.

BACKGROUND: In critical situations such as the COVID-19 pandemic, nurses always face a lot of stress that can increase their turnover intention. Since a suitable safety climate in the workplace is considered an important factor in preventive management of occupational hazards and people's adaptation to stressful conditions, the present study aimed to determine Turnover intention among operating room nurses during the COVID-19 outbreak and its association with perceived safety climate. METHODS: In this descriptive correlational study, participants were 190 operating room nurses working at public hospitals in Mazandaran (Iran) who were selected by stratified random sampling. Data were collected using the Anticipated Turnover Scale and the Nurses' Safety Climate Questionnaire and analyzed using SPSS16. RESULTS: The results of the linear regression analysis revealed that safety climate significantly reduced turnover intention among nurses in the COVID-19 pandemic (P < 0.001). An increase of one unit in the total score of safety climate led to a 0.6 reduction in the turnover intention of operating room nurses. CONCLUSION: The present findings demonstrated an unfavorable safety climate perceived by perioperative nurses in the COVID-19 pandemic, with a significant inverse relationship with turnover intention. Strategies such as training personnel on the prevention of the disease transmission in the surgery of patients infected with or suspected of COVID-19, creating a proper supportive environment for personnel, and providing appropriate protective equipment to prevent infection with COVID-19 seem absolutely vital to improving the safety climate in the operating room, thereby reducing turnover intention.

Perceptions of Safety and Stress Among Health Professionals: The Role of Care Unit Identification as a Protective Factor During the COVID-19 Pandemic.

The present study aimed to investigate the role of motivational process and coping resources in health professionals during the COVID-19 emergency examining the role of Care Unit Identification and safety climate perception as resources that can help nurses to cope with stressors. A cross-sectional research design was used and 218 nurses completed a self-report questionnaire measuring: Perception of safety, Care Unit identification, Work Engagement, Psychological Distress, and Burnout. Results revealed that Work Engagement was significantly related with Burnout (b = -0.209, 95%CI [-0.309; -0.109]) and Distress (b = -0.355, 95%CI [-0.529; -0.18]) especially when the Care Unit identification is high (b = -0.303, 95%CI [-0.448; -0.157] and b = -0.523, 95%CI [-0.772; -0.275], respectively). The safety perception was positively related to Work Engagement (b = 0.315, 95%CI [0.198; 0.433]) and had an indirect effect on psychological Distress (b = -0.112, 95%CI [-0.181; -0.042]) and Burnout (b = -0.066, 95%CI [-0.105; -0.027]). High levels of both Care Unit identification and perception of safety, along with personal work engagement, appear to protect nurses from burnout and psychological distress. Findings suggest that the effort to improve teamwork identification and ensures an adequate degree of perceived safety for healthcare professionals need to be maintained and reinforced as they positively impact nurses' wellbeing.

Safety priority, safety rules, safety participation and safety behaviour: the mediating role of safety training.

Objectives. This study explores the effects of employee perception of the management's safety priority, safety rules and safety training on safety participation and safety behaviour decided by management, as well as the mediating role of safety training on the other four dimensions. Methods. The study covers employees working in 27 metal companies classed as hazardous/very hazardous in Turkey. The research data were collected by surveying 822 employees in the metal sector. Collected data were tested through explanatory and confirmatory factor analyses, in that order. Results. The findings of this analysis indicated statistically direct, positive effects of safety priority on safety rules and safety training, such an effect of safety rules on safety training, and again such effects of safety training on safety participation and safety behaviour. Besides, indirect relationships were detected between safety priority and safety rules and safety participation, and safety behaviour through the mediating role of safety training. Conclusion. Employee participation in health and safety issues as well as safe behaviour in the workplace depend on management prioritizing health and safety issues as much as production, formulating safe working rules, procedures and practices using comprehensive and regular training programmes.

Psychosocial Safety Climate Moderates the Effect of Demands of Hospital Accreditation on Healthcare Professionals: A Longitudinal Study.

Hospital accreditation has been studied comprehensively, yet few studies have observed its impacts on the burnout and work engagement levels of frontline healthcare professionals (HCPs). With a sample of 121 HCPs working in the United Arab Emirates' public hospitals, this study used a two-wave, cross-lagged panel design to examine the direct effects of job demands and job resources during hospital accreditations on burnout and work engagement and the moderating roles of psychosocial safety climate (PSC) on burnout and work engagement 3 months after accreditation. The data were analyzed using moderated structural equation modeling. As expected, we found that job demands (i.e., accreditation demands) had a direct effect on burnout, while job resources (i.e., social support) predicted work engagement. PSC moderated both relationships; however, it was not able to directly predict burnout or work engagement. Findings from this study show a positive relationship between accreditation demands and HCPs' health. Future research needs to examine the link between PSC and job demands-resources concepts before and after hospital accreditation more closely by using multiple time points to assess the causality relationships between predictor and outcome variables.

Modeling of occupational safety and health factors in production organizations and the formation of measuring scales of occupational safety climate.

This article explores the impact of the main occupational safety and health (OSH) factors in the overall OSH climate of production organizations in the territory of the Republic of Serbia, South Serbia, as an important segment of their strategic development. The article aims to validate and test the proposed conceptual model of OSH. Hence, the SmartPLS methodology was applied. Statistical analysis was performed using SPSS version 21.0. The hypothesized model was developed and tested on a sample of 871 participants employed in production companies. The results indicate that the development of an OSH climate in production organizations primarily depends on the commitment of the management to the OSH system. The results obtained indicate that the methods used in this research can be successfully used in order to identify the OSH factors in the work process, and thus to manage the quality of the work environment.

Assessment of Workplace Safety Climate among Healthcare Workers during the COVID-19 Pandemic in Low and Middle Income Countries: A Case Study of Nigeria.

The COVID-19 pandemic has presented several organizations with the opportunity to review their operational strategies, as well as the existing safety climate within their establishments. The healthcare sector is not an exception, especially those in Low and Middle Income Countries (LMICs), where most safety systems are not robust when compared with developed countries. The study aim is to assess the occupational safety climate among healthcare workers (HCWs) in LMICs using Nigeria as a case study. A cross-sectional study was adopted to measure safety climate perception among professionals working in healthcare establishment during the COVID-19 pandemic using a validated Nordic Safety Climate Questionnaire (NOSACQ-50). At the end of the survey period, 83% (433) of the responses were adjudged to have met the threshold criteria and were used to inform the study outcome. Worker safety commitment within the healthcare facilities (M = 3.01, SD = 0.42) was statistically significantly higher than management safety priority, commitment, and competence (M = 2.91, SD = 0.46), t(130.52), p < 0.001. A significant effect of the management role was found in regards to management safety priority, commitment, and competence (F(1, 406) = 3.99, p = 0.046, η2 = 0.010). On the contrary, the managerial position does not have a significant effect on worker safety commitment (F(1, 417) = 0.59, p = 0.440, η2 = 0.001). The outcome from the study showed that, where there is active promotion of a positive safety climate in healthcare sectors in LMICs, employees are more likely to engage in positive safety behaviour. To help address the identified gaps, there is the need for more effort to be made towards promoting an effective and positive safety climate across the establishment, including management and healthcare worker commitments.

Where to focus? Insights from safety personnel and external safety consultants on lessons learned about safety climate interventions - A qualitative approach.

INTRODUCTION: Safety climate is important for promoting workplace safety and health. However, there is a dearth of empirical research on the effective ways of planning, designing, and implementing safety climate interventions, especially regarding what is going to be changed and improved. To address this gap, the present study sought to extract a comprehensive pool of compiled suggestions for safety climate intervention based on qualitative interviews with professionals in occupational safety and health management from potentially hazardous industries. METHOD: A series of systematic semi-structured interviews, guided by a comprehensive sociotechnical systems framework, were conducted with company safety personnel (n = 26) and external safety consultants (n = 15) of 21 companies from various industries. The taxonomy of five work system components of the sociotechnical systems approach served as overarching themes, representing different areas of improvement in an organization for occupational safety and health promotion, with an aim of enhancing safety climate. RESULTS: Of the 36 codes identified, seven codes were based on the theme of external environment work system, four were based on the theme of internal environment work system, five were based on the theme of organizational and managerial structure work system, 14 codes were based on the theme of personnel subsystem, and six were based on the theme of technical subsystem. CONCLUSIONS: Safety climate intervention strategies might be most commonly based upon the principles of human resource management (i.e., codes based on the personnel subsystem theme and organizational and managerial structure work system theme). Meanwhile, numerous attributes of external/internal environment work system and technical subsystem can be jointly improved to bolster safety climate in a holistic way. Practical Applications: More systematic and organized management of safety climate would be available when various interrelated codes pertinent to a given context are carefully considered for a safety climate intervention.

How Safety Climate Influences the Willingness to Stay of Nursing Staff during the COVID-19 Outbreak.

The outbreak of COVID-19 in China at the beginning of 2020 has made the problems that the aged care agency face with large mobility and high turnover of aged nursing staff become more serious. Aiming at this problem, this paper incorporates psychological capital and social panic into the model from the perspective of the organizational safety climate and constructs a theoretical model of the mechanism of the effect on nursing staff's willingness to stay in the context of the outbreak. Through a questionnaire survey in an aged care agency in Anhui Province, a total of 321 valid questionnaires were collected for empirical analysis. The results show that: (1) the safety climate of the organization has a significant positive impact on the transactional psychological capital and interpersonal psychological capital of nursing staff in the aged care industry and their willingness to stay; (2) transactional psychological capital and social panic have a significant positive impact on the willingness to stay of nursing staff, while interpersonal psychological capital has no significant impact on the willingness to stay; (3) the mediating role of transactional psychological capital and interpersonal psychological capital between the safety climate and the willingness to stay is established, and the moderating role of social panic between psychological capital and willingness to stay is also established. Finally, based on the research conclusions, corresponding countermeasures and suggestions are put forward to deal with the problems that occur in special periods.

Assessment of Attitude of Primary Care Medical Staff Toward Patient Safety Culture in Primary Health-care Centers--Al-Ahsa, Saudi Arabia.

INTRODUCTION: An effective leadership is critical to the development of a safety culture within an organization. Patient safety in primary health care is an emerging field of research of increasing importance. OBJECTIVE: This study has been conducted to explore the safety culture attitude toward patient safety to improve the quality and patient safety in primary health-care centers. METHODS: A cross-sectional survey involving 288 medical staff in primary health-care centers in Al-Ahsa was conducted using an Arabic translated safety attitude questionnaire to assess the safety attitudes among health care center staff toward patient safety culture. RESULTS: This study showed that the attitude of medical staff in primary health-care centers is somewhat positive toward patient safety culture where the average of job satisfaction score in the current study was higher at 80% and the overall score for safety climate was 68%. The overall score for safety attitudes was highest in Al-Ayoun Health Center (79%) and lowest in Al Faisaliah Health Center (58%). The score of teamwork and stress recognition was high and statistically significant (p<0.05) among females. However, staff perception toward management was significantly higher (p<0.05) among males. Staff perception toward management was significantly low (p<0.05) among clinicians. The overall score for safety attitudes was remarkably high (p<0.05) among those with less than 10 years' experience, the overall safety culture score was significantly high (p<0.05) among administrative staff and all correlations were significant (p<0.01) except for recognition of stress with teamwork, job satisfaction, management perception, and safety climate. In addition, there were different attitudes toward patient safety culture between gender and physician vs non-physician and management staff vs non-management staff. CONCLUSION: The findings suggested that certain improvements are needed, especially in the field of communication and stress recognition with regard to patient safety culture.