Factors associated with patient safety management activities among clinical nurses
Abstract
Background: Nurses play a critical role in preventing patient safety incidents through the implementation of patient safety management activities. However, evidence on the individual and organizational factors related to these activities among clinical nurses in Indonesian hospitals remains limited.
Objective: This study aimed to identify factors associated with patient safety management activities among clinical nurses.
Methods: This cross-sectional study was conducted in three hospitals in Malang Raya, East Java, Indonesia, involving 225 nurses recruited using proportional quota sampling. Data were collected using the Nurse Professional Competence Scale, the Practice Environment Scale of the Nursing Work Index, the Safety Motivation Tool, and the Safety Care Activity Scale. Data analysis included descriptive statistics, bivariate analysis (Mann-Whitney test, Kruskal-Wallis test, and Spearman correlation), and multiple linear regression.
Results: The final regression model indicated that motivation (β = 0.762, p < 0.001) and work environment (β = 0.161, p < 0.001) were significantly associated with patient safety management activities, explaining 68.9% of the variance.
Conclusion: These findings highlight the importance of nurse motivation and supportive work environments in strengthening patient safety practices, while providing empirical evidence on the combined role of individual and organizational factors in Indonesian hospital settings.
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References
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22. Halabi JO, Nilsson J, Lepp M. Professional Competence Among Registered Nurses Working in Hospitals in Saudi Arabia and Their Experiences of Quality of Nursing Care and Patient Safety. J Transcult Nurs. 2021;32(4):425-433. doi:10.1177/1043659621992845
23. Zaitoun RA, Said NB, de Tantillo L. Clinical nurse competence and its effect on patient safety culture: a systematic review. BMC Nurs. 2023;22(1):1-10. doi:10.1186/s12912-023-01305-w
24. Zaitoun RA. Assessing nurses’ professional competency: a cross-sectional study in Palestine. BMC Nurs. 2024;23(1):1-12. doi:10.1186/s12912-024-02064-y
25. Kim MS, Cho YO, Park J. Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small–Medium-Sized Hospitals: A Cross-Sectional Study. Nurs Reports. 2022;12(4):861-872. doi:10.3390/nursrep12040083
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28. Lake ET, Gil J, Moronski L, McHugh MD, Aiken LH, Lasater KB. Validation of a short form of the practice environment scale of the nursing work index: The PES-5. Res Nurs Heal. 2024;47(4):450-459. doi:10.1002/nur.22388
29. Nilsson J, Engström M, Florin J, Gardulf A, Carlsson M. A short version of the nurse professional competence scale for measuring nurses’ self-reported competence. Nurse Educ Today. 2018;71(March):233-239. doi:10.1016/j.nedt.2018.09.028
30. Grande RAN, Berdida DJE, Cornejo LTO, et al. Psychometric testing of the nurse professional competence scale Arabic version: An exploratory and confirmatory factor analyses. Nurse Educ Pract. 2023;70(June):103679. doi:10.1016/j.nepr.2023.103679
31. Vinodkumar MN, Bhasi M. Safety management practices and safety behaviour: Assessing the mediating role of safety knowledge and motivation. Accid Anal Prev. 2010;42(6):2082-2093. doi:10.1016/j.aap.2010.06.021
32. Subramaniam C, Johari J, Mashi MS, Mohamad R. The influence of safety leadership on nurses’ safety behavior: The mediating role of safety knowledge and motivation. J Safety Res. 2023;84:117-128. doi:10.1016/j.jsr.2022.10.013
33. Yang YK. Development of a patient safety care activity scale for clinical nurses in Korea. Arch Public Heal. 2021;79(1):79. doi:10.1186/s13690-021-00596-2
34. Saleh MO, Eshah NF, Rayan AH. Empowerment Predicting Nurses’ Work Motivation and Occupational Mental Health. SAGE Open Nurs. 2022;8. doi:10.1177/23779608221076811
35. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemp Educ Psychol. 2020;61(April):101860. doi:10.1016/j.cedpsych.2020.101860
36. Ha TTN, Thanh PQ, Huong TL, et al. Nurses’ perceptions about patient safety culture in public hospital in Vietnam. Appl Nurs Res. 2023;69(March 2022):151650. doi:10.1016/j.apnr.2022.151650
37. Nascimento A, Jesus É. Nursing Work Environment and Patient Outcomes in a Hospital Context: A Scoping Review. J Nurs Adm. 2020;50(5):261-266. doi:10.1097/NNA.0000000000000881
38. Yuk S, Yu S. The Effect of Professional Autonomy and Nursing Work Environment on Nurses’ Patient Safety Activities: A Perspective on Magnet Hospitals. Goh SYS, ed. J Nurs Manag. 2023;2023. doi:https://doi.org/10.1155/2023/5587501
39. Ibrahim El-Sayed AA, Ramadan Asal MG, Farghaly Abdelaliem SM, Alsenany SA, Elsayed BK. The moderating role of just culture between nursing practice environment and oncology nurses’ silent behaviors toward patient safety: A multicentered study. Eur J Oncol Nurs. 2024;69(January):102516. doi:10.1016/j.ejon.2024.102516
40. Jarzynkowski P, Piotrkowska R, Mędrzycka-Dąbrowska W, Książek J. Areas of work life as predictors of occupational burnout of nurses and doctors in operating theaters in poland—multicenter studies. Healthc. 2022;10(1). doi:10.3390/healthcare10010026
41. Mansour H, Abu Sharour L. Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload. J Healthc Qual Res. 2021;36(6):370-377. doi:10.1016/j.jhqr.2021.05.001
42. Putra KR, Sutadi H, Setyowati S, Hariyati RTS. The impact of nurse manager caring behaviors and work environment on burnout syndrome among nurses. Kontakt. 2021;23(2):90-96. doi:10.32725/kont.2021.019
43. Skela-Savič B, Squires A, Sermeus W, Lobe B, Dello S, Bahun M. Self-assessment of the characteristics of nurses’ work environment and psychometric analysis of the Slovene-language version of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Obz Zdr nege. 2024;58(1):7-17. doi:10.14528/snr.2024.58.1.3212
44. Mahdy Attia Mohamed N, Sobhy Mohamed H. Relationship among Nursing Work Environment, Professional Competencies, Patient Safety Culture, and Attitude toward Incident Report. Egypt J Heal Care. 2024;15(3):973-984. doi:10.21608/ejhc.2024.383446
2. Hernan AL, Giles SJ, Carson-Stevens A, et al. Nature and type of patient-reported safety incidents in primary care: Cross-sectional survey of patients from Australia and England. BMJ Open. 2021;11(4):1-14. doi:10.1136/bmjopen-2020-042551
3. Singh S, Mahomed O. Nature and type of patient-reported safety incidents at a tertiary hospital in South Africa during the COVID-19 period (2018-2021)- A retrospective review. PLoS One. 2023;18(11 November):1-13. doi:10.1371/journal.pone.0293933
4. Dhamanti I, Saputra SA, Suryadarma AY, Immanuel T. Report: Insiden Keselamatan Pasien Di Indonesia Tahun 2021. Center Of Excellence For Patient Safety And Quality; 2024.
5. Almanhali R, Al Sabei SD, Matua Amandu G. Nurses’ attitudes towards patient safety and their relationship to adverse patient events in Oman. J Res Nurs. Published online 2024. doi:10.1177/17449871241278860
6. Lee Y, Cho E. Predictors of patient safety activities among registered nurses and nurse aides in long-term care facilities: cross-sectional study. BMC Geriatr. 2022;22(1):541. doi:10.1186/s12877-022-03234-w
7. Kim SH, Kim YH. Influence of Awareness of Patient Participation Culture on Patient Safety Nursing Activities among Nurses in General Hospitals. J Muscle Jt Heal. 2024;31 No 3:179-188. doi:10.5953/JMJH.2024.31.3.179
8. World Health Organization. Global Patient Safety Report 2024. Vol 4.; 2024.
9. Ramsay A, Hartin P, McBain-Rigg K, Birks M. Advocating for patient safety: Power dynamics in nurse advocacy practice in Australia—An integrative review. Collegian. 2025;32(2):84-99. doi:10.1016/j.colegn.2025.01.003
10. Jeong S, Jeong SH. Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis. J Korean Acad Nurs. 2022;52(4):363. doi:10.4040/jkan.22022
11. Janes G, Mills T, Budworth L, Johnson J, Lawton R. The Association between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis. J Patient Saf. 2021;17(3):207-216. doi:10.1097/PTS.0000000000000807
12. Astarini MIA, Lilyana MTA. Internal and External Factors Related to The Implementation of Patient Safety Goals: A Literature Review. Nurse Holist Care. 2021;1(3):112-119. doi:10.33086/nhc.v1i3.2530
13. Cho H, Sagherian K, Steege LM. Latent Profiles of Nurses’ Insomnia, Fatigue, Recovery, Psychological Distress and Burnout During the COVID-19 Pandemic: Examining the Role of Organisational Support. J Adv Nurs. Published online May 2025. doi:10.1111/jan.17067
14. Hennus MP, Young JQ, Hennessy M, et al. Supervision, Interprofessional Collaboration, and Patient Safety in Intensive Care Units during the COVID-19 Pandemic. ATS Sch. 2021;2(3):397-414. doi:10.34197/ats-scholar.2020-0165OC
15. El-Gazar HE, Abdelhafez S, Zoromba MA. Effects of the areas of worklife on job embeddedness: a national cross-sectional study among Egyptian nurses. BMC Nurs. 2022;21(1):1-9. doi:10.1186/s12912-022-01107-6
16. Fan S, Zhou S, Ma J, An W, Wang H, Xiao T. The role of the nursing work environment, head nurse leadership and presenteeism in job embeddedness among new nurses: a cross-sectional multicentre study. BMC Nurs. 2024;23(1):1-11. doi:10.1186/s12912-024-01823-1
17. Arsani SH, Ahsan, Fevriasanty FI. Analysis Dimension of Healty Work Environment for Successful Patient Safety Incident Reporting: A Cross Sectional Study. JMMR (Jurnal Medicoeticolegal dan Manaj Rumah Sakit). 2023;12(1):32-45. doi:10.18196/jmmr.v12i1.29
18. Alhidayah T, Susilaningsih FS, Somantri I. Factors Related with Nurse Compliance in the Implementation of Patient Safety Indicators at Hospital. J Keperawatan Indones. 2020;23(3):170-183. doi:10.7454/jki.v23i3.975
19. Kim JH, Jang H. Effects of Grit, Patient Safety Competence, and Patient Safety Culture on the Patient Safety Nursing Activities of Nurses in Comprehensive Nursing Service Wards. J Korean Crit Care Nurs. 2024;17(3):62-75. doi:10.34250/jkccn.2024.17.3.62
20. Manalu CH, Anindita R, Mustikawati IS. the Effect of Safety Management Commitment and Motivation on Compliance Implementing Patient Safety Goals Through a Culture of Patient Safety. J Adm Rumah Sakit Indones. 2024;10(1). doi:10.7454/arsi.v10i1.7319
21. Ahlstedt C, Eriksson Lindvall C, Holmström IK, Muntlin Å. Flourishing at work: Nurses’ motivation through daily communication – An ethnographic approach. Nurs Heal Sci. 2020;22(4):1169-1176. doi:10.1111/nhs.12789
22. Halabi JO, Nilsson J, Lepp M. Professional Competence Among Registered Nurses Working in Hospitals in Saudi Arabia and Their Experiences of Quality of Nursing Care and Patient Safety. J Transcult Nurs. 2021;32(4):425-433. doi:10.1177/1043659621992845
23. Zaitoun RA, Said NB, de Tantillo L. Clinical nurse competence and its effect on patient safety culture: a systematic review. BMC Nurs. 2023;22(1):1-10. doi:10.1186/s12912-023-01305-w
24. Zaitoun RA. Assessing nurses’ professional competency: a cross-sectional study in Palestine. BMC Nurs. 2024;23(1):1-12. doi:10.1186/s12912-024-02064-y
25. Kim MS, Cho YO, Park J. Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small–Medium-Sized Hospitals: A Cross-Sectional Study. Nurs Reports. 2022;12(4):861-872. doi:10.3390/nursrep12040083
26. WORLD HEALTH ORGANIZATION. Global Patient Safety Action Plan 2021-2030: Towards Eliminating Avoidable Harm in Health Care, WHO, Geneva, (2021).; 2021.
27. STARKES. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/1596/2024 Tentang Standar Akreditasi Rumah Sakit. Kementeri Kesehat RI. Published online 2024:1-356.
28. Lake ET, Gil J, Moronski L, McHugh MD, Aiken LH, Lasater KB. Validation of a short form of the practice environment scale of the nursing work index: The PES-5. Res Nurs Heal. 2024;47(4):450-459. doi:10.1002/nur.22388
29. Nilsson J, Engström M, Florin J, Gardulf A, Carlsson M. A short version of the nurse professional competence scale for measuring nurses’ self-reported competence. Nurse Educ Today. 2018;71(March):233-239. doi:10.1016/j.nedt.2018.09.028
30. Grande RAN, Berdida DJE, Cornejo LTO, et al. Psychometric testing of the nurse professional competence scale Arabic version: An exploratory and confirmatory factor analyses. Nurse Educ Pract. 2023;70(June):103679. doi:10.1016/j.nepr.2023.103679
31. Vinodkumar MN, Bhasi M. Safety management practices and safety behaviour: Assessing the mediating role of safety knowledge and motivation. Accid Anal Prev. 2010;42(6):2082-2093. doi:10.1016/j.aap.2010.06.021
32. Subramaniam C, Johari J, Mashi MS, Mohamad R. The influence of safety leadership on nurses’ safety behavior: The mediating role of safety knowledge and motivation. J Safety Res. 2023;84:117-128. doi:10.1016/j.jsr.2022.10.013
33. Yang YK. Development of a patient safety care activity scale for clinical nurses in Korea. Arch Public Heal. 2021;79(1):79. doi:10.1186/s13690-021-00596-2
34. Saleh MO, Eshah NF, Rayan AH. Empowerment Predicting Nurses’ Work Motivation and Occupational Mental Health. SAGE Open Nurs. 2022;8. doi:10.1177/23779608221076811
35. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemp Educ Psychol. 2020;61(April):101860. doi:10.1016/j.cedpsych.2020.101860
36. Ha TTN, Thanh PQ, Huong TL, et al. Nurses’ perceptions about patient safety culture in public hospital in Vietnam. Appl Nurs Res. 2023;69(March 2022):151650. doi:10.1016/j.apnr.2022.151650
37. Nascimento A, Jesus É. Nursing Work Environment and Patient Outcomes in a Hospital Context: A Scoping Review. J Nurs Adm. 2020;50(5):261-266. doi:10.1097/NNA.0000000000000881
38. Yuk S, Yu S. The Effect of Professional Autonomy and Nursing Work Environment on Nurses’ Patient Safety Activities: A Perspective on Magnet Hospitals. Goh SYS, ed. J Nurs Manag. 2023;2023. doi:https://doi.org/10.1155/2023/5587501
39. Ibrahim El-Sayed AA, Ramadan Asal MG, Farghaly Abdelaliem SM, Alsenany SA, Elsayed BK. The moderating role of just culture between nursing practice environment and oncology nurses’ silent behaviors toward patient safety: A multicentered study. Eur J Oncol Nurs. 2024;69(January):102516. doi:10.1016/j.ejon.2024.102516
40. Jarzynkowski P, Piotrkowska R, Mędrzycka-Dąbrowska W, Książek J. Areas of work life as predictors of occupational burnout of nurses and doctors in operating theaters in poland—multicenter studies. Healthc. 2022;10(1). doi:10.3390/healthcare10010026
41. Mansour H, Abu Sharour L. Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload. J Healthc Qual Res. 2021;36(6):370-377. doi:10.1016/j.jhqr.2021.05.001
42. Putra KR, Sutadi H, Setyowati S, Hariyati RTS. The impact of nurse manager caring behaviors and work environment on burnout syndrome among nurses. Kontakt. 2021;23(2):90-96. doi:10.32725/kont.2021.019
43. Skela-Savič B, Squires A, Sermeus W, Lobe B, Dello S, Bahun M. Self-assessment of the characteristics of nurses’ work environment and psychometric analysis of the Slovene-language version of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Obz Zdr nege. 2024;58(1):7-17. doi:10.14528/snr.2024.58.1.3212
44. Mahdy Attia Mohamed N, Sobhy Mohamed H. Relationship among Nursing Work Environment, Professional Competencies, Patient Safety Culture, and Attitude toward Incident Report. Egypt J Heal Care. 2024;15(3):973-984. doi:10.21608/ejhc.2024.383446
Authors
Agustina, C., Putra, K. R., Fevriasanty, F. I., & Kusumaningsih, A. (2026). Factors associated with patient safety management activities among clinical nurses. JURNAL RISET KESEHATAN POLTEKKES DEPKES BANDUNG, 18(1), 243–252. https://doi.org/10.34011/juriskesbdg.v18i1.3224
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