Performance Obstacles and Their Effects on Patient Safety among Intensive Care Unit Nurses at Selected Hospitals in Sana'a City-Yemen

Abstract

Background: Nurses in intensive care units confront various challenges and problems during their everyday work that adversely affect performance and patient safety. Patient safety refers to the prevention of errors to patients during health care. The work environment of intensive care nurses may have substantial impact on both nursing outcomes and patient safety.

General objective: The general objective of this study was to explore performance obstacles and their effects on patient safety attitudes among intensive care unit nurses at selected hospitals in Sana'a city, Yemen.

Methodology: A descriptive cross-sectional study was conducted between 1st March and 30th May 2019. A stratified simple random sampling of 230 nurses was drawn from a total population of N=541 to select the sample size from the intensive care units at six governmental and private hospitals. A self-administered questionnaire was used to collect data by using performance obstacles questionnaire, and safety attitudes questionnaire (ICU version). The data were entered, analyzed by descriptive and inferential statistics and tabulated using the Statistical Package for Social Sciences Version 21.

Results: The study depicted that more than a half of ICU nurses (61.7%) were belonging to age group (20-29years) and the mean age was 29.3± 4.8 years. Among the participants 55.2%. were female, 51.7% were single, 98.3% were Yemeni nurses and 47.0% had Higher Diploma degree. About (64.8 %) of ICU nurses had working experience from 1-5 years and their mean work ICU experience was 5.3±4.9 years. The majority of participants were working more than one shift types and two thirds of them affirmed that they received help on time from other nursing. In relation to the training course of the participants, (60.4%) of them had ICU training course compared to only (39.6%) of them had not attended. Followed by training course in patient safety (53.0%) of them had not attended and the field of stress management (69.6%) of them had not attended. The common obstacles included the patients rooms are close to each other, trouble noise, delay in getting patients’ medications, poor conditioned materials used, equipment are not existed in place when needed, and "spending time dealing with family needs. The study showed that the correlation between performance obstacles total score & patient safety attitudes total score was found very high statically significant negative correlation **p<0.000). There was statistical significant association between the years of nurse experiences in ICU and the total performance obstacles. In this study (72.6%) of participants were rated their patient safety attitudes as being moderate level, (18.7%) of them were rating their patient safety attitudes as high level and only (8.7%) of them were rating their patient safety attitudes as low level. Regarding workplace characteristics (background), this study presented that there was high statistically significant negative correlation in item of "Number of hours worked daily and patient safety attitudes total scores **p<0.006). There was no statistically associated between patient safety attitudes total score and demographic characteristics data regarding age (P-value= 0.296), education level of (P-value=0.225), years 'experience (P-value=0.583).

Conclusion: The study conclude that the common obstacles included the patients rooms are close to each other, trouble noise, delay in getting patients’ medications, poor conditioned materials used, equipment are not existed in place when needed, and "spending time dealing with family needs. Also, there was very high statistically significant negative correlation between total performance obstacles scores and total patient safety attitudes scores.

Recommendations: Decision makers in selected hospitals must develop strategy aimed at redesigning the work system of critical care units to eliminate performance obstacles. Health care organizations can use the findings of the present study as a blueprint to improve work environment and increase the retention of critical care nurses instead of helping nursing assistants and unit clerks to eliminate performance obstacles and enhance patient safety. Future researches that more quantitative and qualitative studies be conducted to evaluate the strategies of overcoming performance obstacles to the establishment of the quality and safety culture. Future research should investigate the impact of reducing performance obstacles on ICU nurses’ workload and other outcomes.

Keywords: ICU, nurses, performance obstacles, patient safety attitudes.