Evidence on the Patient Safety Culture and Nursing Work Environment in Iran

Document Type : Original Article


1 Department of Nursing, Urmia University of Medical Sciences, Khoy University of Medical Sciences, Iran, Khoy.

2 Student Research Center, Urmia University of Medical Sciences, Khoy University of Medical Sciences, Iran, Khoy.


Introduction: Patient safety is a universal concern with numerous gaps requiring research. Nurses are the largest workforce in healthcare system and play a pivotal role in the profitability and patient safety indices in hospitals. The present study aimed to evaluate the perception of nurses toward the patient safety culture and nursing work environment in Iran. 
Materials and Methods: This cross-sectional study was conducted on 100 nurses in Khoy, located in West Azerbaijan, Iran. Data were collected using the hospital survey on patient safety culture (HSPSC), which was completed by the participants during July 1st-30th 2017. Data analysis was performed in SPSS version 19.
Results:Positive response rate was 7-82% for 42 items in the HSPSC. The highest positive response rate was in the item "When one area in the ward becomes very busy, others help out." (82%), whereas the lowest rate was in the item "We have enough staff to handle the workload." (7%). In addition, the lowest positive response rate belonged to the dimension of ‘staffing’ (21%), while the highest rate belonged to the dimension of ‘teamwork within units’ (76%).
Conclusion: According to the results, nurses had a positive perception toward teamwork. However, they believed that the number of the staff to manage the workload was insufficient and occasionally caused poor interactions among the staff. As an external quality evaluation tool, accreditation could be applied to develop the patient safety culture. Therefore, further investigation is recommended regarding the influence of hospital accreditation on the patient safety culture in Iran.


1- World Health Organization. World alliance for patient safety: forward programme 2005.
2- Bates DW, Sheikh A. The role and importance of cognitive studies in patient safety.
3- Van Doormaal JE, Van den Bemt PM, Mol PG, Zaal RJ, Egberts AC, Haaijer-Ruskamp FM, Kosterink JG. Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. BMJ Quality & Safety. 2009 Feb 1;18(1):22-7.
4- Ahmed M, Arora S, Baker P, Hayden J, Vincent C, Sevdalis N. Building capacity and capability for patient safety education: a train-the-trainers programme for senior doctors. BMJ Qual Saf. 2013 Aug 1;22(8):618- 25.
5- Thomas AN, Taylor RJ. An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012. Anaesthesia. 2014 Jul;69(7):735-45.
6- Griffiths P, Jones S, Maben J, Murrells T. State of the art metrics for nursing: a rapid appraisal. Kings Colege Lonondon; 2008 Jan 1.
7- Maben J, Morrow E, Ball J, Robert G, Griffiths P. High quality care metrics for nursing; 2012.
8- Duffield C, Roche M, O’Brien-Pallas L, Diers D, Aisbett C, King M, Aisbett K, Hall J. Glueing it together: Nurses, their work environment and patient safety. Sydney: University of Technology. 2007 Jul.
9- Stone PW, Mooney-Kane C, Larson EL, Horan T, Glance LG, Zwanziger J, Dick AW. Nurse working conditions and patient safety outcomes. Medical care. 2007 Jun 1:571-8.
10- Mitchell PH. Defining patient safety and quality care; 2008.
11- Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. International journal for quality in health care. 2008 Mar 28;20(3):172-83.
12- Jha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW. Patient safety research: an overview of the global evidence. BMJ Quality & Safety. 2010 Feb 1;19(1):42- 7.
13- Cho E, Sloane DM, Kim EY, Kim S, Choi M, Yoo IY, Lee HS, Aiken LH. Effects of nurse staffing, work environments, and education on patient mortality: an observational study. International journal of nursing studies. 2015 Feb 1;52(2):535-42.
14- Van Bogaert P, Dilles T, Wouters K, Van Rompaey B. Practice environment, work characteristics and levels of burnout as predictors of nurse reported job outcomes, quality of care and patient adverse events: a study across residential aged care services. Open journal of nursing. 2014;4(5):343-55.
15- Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International journal of nursing studies. 2013 Feb 1;50(2):253-63.
16- Rochefort CM, Clarke SP. Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of advanced nursing. 2010 Oct;66(10):2213-24.
17- US Department of Health and Human Services. Agency for Healthcare Research and Quality. Hospital Nurse Staffing and Quality of Care; 2008.
18- Momeni B, Golpira R, Mayelafshar M. The study of the domains of patient safety culture in Rajaie Cardiovascular, Medical and Research Center in 2012. Iranian Journal of Cardiovascular Nursing. 2014 Jun 15;3(1):34-41.
19- Sorra J, Nieva V, Famolaro T, Dyer N. Hospital survey on patient safety culture: 2007 comparative database report. AHRQ Publication No. 07-0025. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Khorami Markani et al Patient Safety and Nursing Environment 643 Patient Saf Qual Improv, Vol. 6, No. 1, Win 2018
20- Marcelino CF, Alves DF, Gasparino RC, Guirardello ED. Validation of the Nursing Work IndexRevised among nursing aides and technicians. Acta Paulista de Enfermagem. 2014 Aug;27(4):305-10.
21- Gozlu K, Kaya S. Patient Safety Culture as Perceived by Nurses in a Joint Commission International Accredited Hospital in Turkey and its Comparison with Agency for Healthcare Research and Quality Data. Journal of Patient Safety & Quality Improvement. 2016;4(4):441-9.
 22- Kiaei MZ, Ziaee A, Mohebbifar R, Khoshtarkib H, Ghanati E, Ahmadzadeh A, Teymoori S, Khosravizadeh O, Zieaeeha M. Patient safety culture in teaching hospitals in Iran: assessment by the hospital survey on patient safety culture (HSOPSC). Journal of Health Management and Informatics. 2016 Mar 14;3(2):51-6.
23- Onã PM. Are there differences in patient safety between different countries using the HSOPSC. Master of Public Health. Copenhagen University, Copenhagen (Denmark). 2012.