The relationship between the qualifications of professional nurses and their perception of patient safety and quality of care in medical and surgical units in South Africa
Blignaut, Alwiena Johanna
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Background: Several international studies have been published on the importance of exploring and describing the perceptions of professional nurses to improve patient safety and quality of care. There is also a growing body of literature that has established the associations of qualifications on patient safety and quality of care. However, no comparable research has been conducted in South Africa, and little is known about the influence of personal characteristics, such as qualifications of the professional nurse, on his/her perception of patient safety and quality of care. Objective: To investigate the perceptions of professional nurses regarding patient safety and quality of care as well as the relationship between the qualifications of professional nurses and these perceptions in medical and surgical units in public and private hospitals in South Africa. Design: Cross-sectional survey of nurses. Setting and participants: 1187 professional nurses (161 Baccalaureate degree and 956 diploma-prepared) working in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in South Africa completed the survey. Measurements: Perceptions of patient safety, quality of care and occurrence of adverse events, qualifications, age, job satisfaction, emotional exhaustion, experience, personal accomplishment and depersonalization. Results: 54.1% (n = 87) of Baccalaureate professional nurses and 51.2% (n = 490) diploma nurses feel as if their mistakes are held against them. 37.9% (n = 61) of Baccalaureate professional nurses and 42.4% (n = 404) diploma nurses perceive important information to be lost during shift changes. 39.1% (n = 63) of Baccalaureate professional nurses and 38.6% (n = 369) diploma nurses feel that things “fall between the cracks” when transferring patients from one unit to another. 43.5% (n = 70) of Baccalaureate professional nurses and 48.7% (n = 465) diploma nurses feel that their hospital‟s managements are not approachable. Almost half of professional nurses (49% [n = 79] Baccalaureate and 44.4% [n = 418] diploma) do not have confidence in hospital management to resolve reported problems regarding patient care. 26.6% (n = 26.8) of Baccalaureate professional nurses and 25.5% (n = 237) of diploma professional nurses perceive the quality of care in their hospitals to have deteriorated. Both Baccalaureate and diploma professional nurses reported adverse events to occur a few times a year or less. Verbal abuse towards nurses is reported to occur once a month or less. Qualifications revealed no correlation with perceptions of patient safety and quality of care, though emotional exhaustion and depersonalization showed a small to medium negative correlation and personal accomplishment a small to medium positive correlation with these perceptions. Conclusions: Supportive leadership and development of an environment in which professional nurses can freely report adverse events and hindering factors with regard to quality of care might benefit patients in terms of safety and better quality care.
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