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Access Type

WSU Access

Date of Award


Degree Type


Degree Name




First Advisor

Stephen J. Cavanagh






May 2010

Advisor: Dr. Stephen J. Cavanagh

Major: Nursing

Degree: Doctor of Philosophy

Patient safety (the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery) has become a major academic and public concern in healthcare. In order to promote and sustain a culture of safety in a healthcare organization, healthcare professionals stress the need to understand both individual and system contributions to error events. However, in Saudi Arabia, little is known about nurses' perceptions of patient safety culture.

The purpose of this research is to identify the systems factors that Registered Nurses (RNs) perceive as contributing to a culture of patient safety and to study the effects these perceptions have on nurses' participation and engagement in the patient safety culture at King Fahad Medical City (KFMC), Saudi Arabia. King's conceptual system was utilized as the theoretical framework for this study.

This study used a quantitative research methodology with a descriptive/correlation design. The sample of this study was registered RNs at KFMC, Saudi Arabia. The Hospital Survey on Patient Safety Culture (HSOPSC) instrument was used to measure perceptions of nurses on patient safety culture.

Copies of the surveys were distributed to 600 RNs. A total of 500 questionnaires were returned. Among these returned questionnaires, 55 were excluded because they had missing responses on more than one complete section of the questionnaire. The total response rate for this study was 83%.

Overall, 52% of the nurses positively perceived patient safety culture at KFMC, which is considered an opportunity for improvement according to AHRQ's definition of areas needing improvement. Nurses responded most positively to two dimensions, hospital management support for patient safety and organizational learning. Nurses responded most negatively to the dimensions of hospital handoffs and transitions, communication openness, non-punitive response to error, and supervisor/manager expectations and actions promoting patient safety.

There were significant differences between nurses' perceptions of patient safety culture and gender, age, years of experience, Arabic vs. non-Arabic speaking, and length of shift; but astonishingly, for level of education, the results were not significantly correlated to any of the HSOPSC dimensions.

Findings from this study provide a description of the current status of patient safety at King Fahad Medical City from the nurses' perspective. The findings will not only provide a baseline from which to work, but they will help raise safety awareness throughout the organization and identify areas most in need of improvement. Findings will lead to the development of interventions to improve patient safety in Saudi Arabia hospitals.