[Safe Working Environments: The Foundation of Patient Safety].

ABSTRACT

Patient safety is a primary concern in the medical and healthcare industry. The safety climate (or culture) of a hospital is determined by the overall perception of its safety policies and the safety-related behaviors of medical staff that affect the quality of care provided by the organization and risk of occupational injury. The perceptions of nurses related to the hospital safety climate relate positively to their behavior in the workplace. An organization's safety culture determines the risk of patient care. Patankar and Sabin (2010) identified safety values, safety leadership, safety climate, and safety performance as important factors affecting the development and improvement of an organization's safety climate. Several papers in the literature have examined the characteristics (Lin et al., 2017), influencing factors (Wagner et al., 2020), outcomes (Arzahan et al., 2022), and improvement strategies (Lee et al., 2019) related to hospital safety climates. The occupational safety of medical staff and their compliance with safety regulations relate closely to patient safety and care outcomes (Hessels & Larson, 2016). The most frequently used outcome indicators of hospital safety culture are mortality rate, length of stay, infection rates, and patient satisfaction. However, unsafe medical environments and work stress may hinder the compliance of medical staff with safety behaviors and affect the value they place on these behaviors. Furthermore, perceiving a working environment as "unsafe" induces physical and mental health problems and dissatisfaction, leading to work stress and causing occupational injuries, physical and mental health issues, increased turnover, and decreased work satisfaction (Arzahan et al., 2022; Kalteh et al., 2021). The working environment of nurses is highly complex and uncertain, and considered to be one of the most hazardous occupational settings. However, guaranteeing a safe and friendly working environment is the responsibility of every organization and also a basic employee right. The International Council of Nurses (International Council of Nurses, 2017) advocates that every nurse has the right to work in a healthy and safe environment that minimizes the risks of injury and illness. Therefore, patient health outcomes should not be the only focus when discussing hospital safety culture, and more attention should be paid to promoting a safe working environment for medical staff as well. In their study conducted in Taiwan, Lin et al. (2022) proposed that the safety climate of hospitals covers six dimensions. Three of these, including "experience of clinical jobs hindering the use of personal protective equipment," "perception of comfort using personal protective equipment," and "easy usage of personal protective equipment", have not been addressed in studies conducted elsewhere. These three dimensions, which all relate directly to work environment safety, earned relatively low mean scores from the nurses surveyed, with "comfort in using personal protective equipment" earning the lowest mean score of all. Although the safety of working environments in medical organizations includes many dimensions (International Council of Nurses, 2017), including biological (infection risk), chemical (chemotherapy drugs), ergonomic (improper design, lifting), physical (radiation, needle stick injuries), and psychological (workload, workplace violence), the accumulated evidence provides insights that administrators may use to further improve hospital safety environments. Lin et al. (2022)'s investigation of nursing management practices related to hazardous antineoplastic drugs found the availability of adequate and appropriate personal protective equipment to be essential to promoting a safe working environment. During the current coronavirus disease pandemic, the three Taiwan-specific dimensions related to personal protective equipment have great value in helping nurse administrators foster and assess the safety climate in their hospitals. In addition to showing that nurses use personal protective equipment for self-protection and the protection of clients, these dimensions also provide to nurse administrators specific directions for creating a safe working environment by providing to nurses adequate, comfortable, and easy-to-use personal protection equipment.