The Relationship between Job Stress and the Perception of Patient Safety Culture among Hospital Nurses in Palestine: Insights from a Large Mixed-Method Study

Abstract

Background: Patient safety is a global concern, with high rates of medical errors reported annually. Understanding the relationship between nurses’ job stress and patient safety culture (PSC) is crucial. Despite their pivotal role in healthcare, nurses face stress due to demanding job roles and the challenging healthcare system in Palestine. This study explored how job stress impacts PSC in Palestinian hospitals, aiming to enhance healthcare outcomes and support healthcare professionals. Methods: The study employed an explanatory sequential mixed-methods approach. Data collection took place from June to September 2023. The study utilized self-reported surveys, including the Hospital Survey of Patient Safety Culture (HSOPSC) and the Nursing Stress Scale (NSS), administered to 355 nurses working in 16 North West Bank hospitals in Palestine. Additionally, semi-structured interviews were conducted with 7 experienced nurses. Quantitative data collected were analyzed using descriptive and inferential analysis, while qualitative data from interviews were analyzed using thematic analysis. Results: The overall nurses' perception of PSC was 47%. The most positive perceived areas were "teamwork", "organizational learning-continuous improvement", and "communication about error". Furthermore, the most common sources of job stress perceived by nurses were "workload" and "death and dying". Statistical tests revealed six factors significantly associated with the perception of PSC. Among these, income, hospital type, activities to improve PSC, patient safety ratings of work areas, and weekly night shifts emerged as predictors of PSC. Additional tests revealed nine factors significantly associated with job stress. Among these, gender, educational level, engagement in stress relief activities, participation in PSC improvement activities, and patient safety ratings emerged as predictors of job stress. VI Moreover, five themes emerged from the qualitative part on PSC, and three on job stress. The study underscored negative correlations between job stress and PSC. Conclusion: The study identified the need for tailored policies and interventions that address nurses' specific stressors to enhance PSC within hospital settings. Moreover, the study shed light on the unique challenges faced by nurses in Palestine, such as limited resources, unemployment concerns, staffing, and transportation issues, which further exacerbated job stress levels and potentially compromised patient safety. Understanding these contextual factors is crucial for developing targeted interventions and support systems that prioritize the holistic well-being of nurses and the quality of patient care delivery. Recommendations: The study recommends investing in training programs that equip nurses with the necessary skills and knowledge related to patient safety; conducting workshops and meetings to raise awareness about patient safety and error reporting; regularly assessing PSC within hospitals and identifying areas for improvement; establishing a robust system for reporting, evaluating, and providing error feedback; implementing a “just culture” strategy; and incorporating PSC into nursing education curriculums in the universities. Key Words: Job Stress, Patient Safety Culture, Patient Safety, Palestine