Date of Award

Fall 12-2018

Degree Name

Doctor of Philosophy (PhD)



Second Advisor


Third Advisor



The objective of this research was to analyze the relationship between nursing safety work culture in inpatient nursing units of a specialty academic hospital and their patients’ perception of safety using quantitative and qualitative methods. The aim of the quantitative study was to quantitatively evaluate whether nursing safety culture, as measured on the Hospital Survey on Patient Safety Culture (HSOPS) safety questions of the institutional employee opinion survey, was associated with patients’ perception of safety during their inpatient care, as measured by responses on the inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The aim of the qualitative study was to explore patients’ and nurses’ perceptions of the experiences about safety through individual interviews. The setting of the study was 14 inpatient nursing units. The sample for the quantitative study was these 14 units. The selected HSOPS and HCAHPS question scores were used for selected domains for a regression analysis. For the qualitative study, 4 units were selected from these 14 units based on their HCAHPS score (top, lowest, and two average performers). A total of 14 nurses and 12 patients were interviewed from these selected units. The quantitative results indicated that there was no significant association between any of the domains of the nurses’ safety culture and the domains of patients’ perception of safety. A possible explanation was the limited vii statistical power, given the fixed sample size of 14 units. In the qualitative study, the nursing themes were the following: High workload and insufficient staff, nurses identified safety risks, and safety climate is favorable. The patient themes were the following: Patients identified safety risks, Communication and caring from nurses is appreciated, Patients noticed nurses work as a team, Insufficient staffing not an issue for patients. The conclusions from the study was that nurses are working in a favorable safety climate and teamwork is important because both nurses and patients recognized it as part of safety, patients perceived safe care and felt that nurses genuinely cared for them, and working and staffing are the highest safety priority for nurses.