Volume 5, No. 6 June, 2024
p ISSN 2723-6927-e ISSN 2723-4339
The Relationship Between Nurse
Burnout and Patient Safety Culture with The Quality of Nursing Care in Type B
Hospitals in Central Sulawesi
Fitria Dewi Susanti1,Sri Andarini2, Kuswantoro Rusca Putra3
1,2,3Brawijaya University, Malang,
Indonesia
Email:
fitriadewisusanti88@gmail.com1,dr.sriandarini.fk@ub.ac.id2, ruscaputra@gmail.com3
ABSTRACT
The hospital provides health
services such as inpatient, outpatient, and emergency departments. The quality
of nursing care is crucial as patients rely on nurses to address their
complaints. This study aims to determine the relationship between nurse burnout
and patient safety culture with the quality of nursing care. An analytical
observational design with a cross-sectional study approach was conducted in two
Type B Hospitals in Central Sulawesi Province with 235 nurse respondents in the
inpatient room, using purposive sampling. Data analysis included the Pearson
product-moment test and multivariate modeling. Results indicated a significant
relationship between nurse burnout and nursing care quality (p-value <0.05),
as well as between patient safety culture and nursing care quality. The
dominant variable related to the quality of nursing care was patient safety
culture (β = 0.723). The study highlights that nurse burnout negatively impacts
the quality of nursing care, whereas a strong patient safety culture improves
it. Theoretically, this research expands the understanding of the interplay
between nurse burnout, patient safety culture, and nursing care quality,
emphasizing the need for organizational support and effective communication.
Practically, it suggests that hospital administrators should implement
strategies to reduce nurse burnout and foster a positive patient safety
culture, such as stress management programs and a supportive work environment,
to enhance nursing care quality and improve patient outcomes.
Keywords: nurse burnout, patient safety
culture, quality nursing care.
INTRODUCTION
Prevalence data
in South Africa shows that 11 – 73% of nurses have poor-quality nursing services in various
hospitals. The average quality of nursing services in Ethiopia shows that 64% are dissatisfied or still poor. In
Indonesia, the results of a survey conducted in 2016 obtained a level of
patient satisfaction with nursing services in inpatient care of 79.22%, and
there are good criteria for the quality of nursing services that have not reached > 90%. The poor
quality of nursing care can be assessed by the level of patient satisfaction,
and this is evidenced by patient satisfaction data at one of the South Sulawesi
Provincial Hospitals in 2021 as much as 70.83%, and Southeast Sulawesi in 2020
as much as 75.97%; The quality of nursing care in Indonesia is still considered
unsatisfactory due to nurses who do not meet patient needs, nurses are less
responsive in handling patient complaints, pay less attention to therapeutic attitudes
to patients in hospitals and are fast and responsive to patient services
The impact of poor quality nursing care can cause patient satisfaction
and comfort with nurse services to be less than optimal. This is in line with
the results of the study, which state that
poor-quality nursing care can have an impact on satisfaction, patient
perception, and an uncomfortable atmosphere among patients, revealing that the quality of good nursing care has
an impact on the level of patient satisfaction, so it really needs attention.
Patient satisfaction influences the assessment dimension of nursing care in
hospitals. Patient satisfaction is critical to hospital continuity, and
dissatisfied customers are less likely to recommend such facilities to their
family, friends, and colleagues.
The issue of
patient safety in hospitals has become very important due to the high rate of
medical errors that occur in many countries. , reported patient safety
incidents where medical errors were experienced by 8-12% of hospitalized
patients, while 23% of Europeans experienced serious
medical errors in hospitals, and 11% of them reported having been
prescribed the wrong medication. The prevalence of patient safety incidents is
found in almost all provinces in Indonesia. From patient safety incident reporting data,
it is recorded that the ranking order that occupies the highest position is DKI
Jakarta at 37.5% and the second position followed by Central Java at 15.9%, and other provinces (D.I.Yogyakarta 13.8%,
East Java at 11.7%, South Sumatra 6.9%, West Java 2.8%,
Bali 1.4%, Aceh 0.7%, and South Sulawesi 0.7%). A patient safety culture is the
result of individual and group values, attitudes, perceptions, skills, and behaviors that determine a hospital's
commitment, style, and capacity for patient safety programs
Some factors related to the role of
nurses in improving patient safety culture include knowledge, attitude, length
of work, motivation, supervision, and training.
Burnout has become a major problem in the nursing profession. High burnout due to their higher job pressure
than other health professionals. Burnout can interfere with nurses' ability to
provide safe, high-quality care, and providing high-quality care should remain a
top priority of the care system. Among health workers, nurses have reported a
higher prevalence of burnout. The frontline caring role that nurses play to
patients at the most vulnerable times makes nurses particularly vulnerable to
burnout, the unrelenting physical and psychological stress derived from
holistic patient care. Nurse burnout occurs when excessive workloads are
compounded by entrenched systemic problems such as irregular working hours,
voluntary overtime, shift changes, and staff shortages. The mismatch between
expectations and the reality of nursing as a profession increases the tendency
to experience burnout
Studies
conducted describing the phenomenon of nurse burnout in several European
countries show that 22 - 34% of nurses experience burnout in providing primary care. The
prevalence of nurse burnout is estimated to range from 19% –
Burnout is
a serious problem among nursing staff, and it has a negative impact on the quality
of care and patient safety
Some
of the factors of burnout are demographic factors (gender, age, education,
length of work), personal factors (work stress, workload, and personality type), and organizational factors (working
conditions and social support). It states that nurse burnout and patient safety
culture relate to patient-perceived nursing care quality outcomes, such as
increased reporting of poor quality of care, patient falls, medication errors,
and infections. The study explained that greater nurse burnout was associated
with poorer quality of care and reduced patient safety among hospital providers.
Based on the results of a preliminary
study conducted through questionnaires and interviews with 20 nurses at Type B
hospitals in Central Sulawesi Province, namely UPT RSUD UNDATA Central Sulawesi
Province and Anuntaloko Parigi Hospital, 12 nurses stated that they felt drained of energy because of the
roles carried out in their work, as many as six nurses stated feeling very
bored and emotionally tired in their work, ten nurses said the lack of
providing education and health promotion to patients was due to the many
practice actions and other supporting nurse duties, eight nurses felt tired when they
woke up in the morning and had to face new work indicated by delays in coming
to official shifts. Based on the results of interviews with the head of the
room, it was found that there were three nurses who did not report
patient safety unless there was an unexpected incident. The observation found
that nurses were not involved in decision-making, conflict management, and teamwork, which had not been well coordinated.
The hospital provides essential health services such
as inpatient, outpatient, and emergency care. Nursing care quality is paramount
as patients depend on nurses to address their complaints and provide
comprehensive care. Recent trends indicate an increasing concern over nurse
burnout, which adversely affects patient safety and care quality
Recent literature highlights the increasing stress and
workload faced by nurses, exacerbated by the COVID-19 pandemic, further
justifying the need for this study
The high
workload of nurses creates pressure on work, making nurses experience burnout. Nurses will experience physical and psychological disorders that can
cause negligence or even neglect of nursing actions that should be given to patients. This is important because the
patient safety culture is a step toward improving the quality of hospital
services and providing
quality nursing care services. Based on this phenomenon, researchers are
interested in conducting research related to the relationship between nurse
burnout and patient safety culture with the quality of nursing care in Type B Hospitals in Central Sulawesi Province.
RESEARCH METHODS
This study used
an analytical observational method with a cross-sectional approach to evaluate
the relationship between nurse burnout and patient safety culture and the quality of nursing care in the Type B
Hospital of Central Sulawesi Province. It involved a population of nurses in
the inpatient room, with a total of 450 nurses, 250 at UPT RSUD UNDATA Central
Sulawesi Province and 200 at RSUD Anuntaloko Parigi.
The minimum
sample required was calculated using the Slovin formula, which yielded 212
respondents. To anticipate the possibility of respondents dropping out, the
sample was added by 10%, bringing the total sample to 235 respondents. The
sampling technique used is purposive sampling, where samples are selected based
on predetermined inclusion and exclusion criteria.
Data was
collected through questionnaires that included variables of nurse burnout,
patient safety culture, and quality of nursing care. The instruments used are
the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) to measure
burnout, the Safety Attitudes Questionnaire (SAQ-INA) to measure patient safety
culture, and the Escala de Percepção das Atividades de Enfermagem que
Contribuem para a qualidade
do Cuidado (EPAECQC) to measure the quality of nursing care.
Validity and
reliability tests were conducted on 30 respondents with the same
characteristics as the study population. The test results show that all three
instruments are valid and reliable. Data was collected over three months, from
August to October 2023, at the two hospitals. Data analysis was conducted to
evaluate the relationship between nurse burnout variables and patient safety
culture with the quality of nursing care. This study aims to provide a better
understanding of the factors that influence the quality of nursing care in
hospitals.
This study employed
an analytical observational design with a cross-sectional study approach to
investigate the relationship between nurse burnout, patient safety culture, and
the quality of nursing care. The research was conducted in two Type B Hospitals
in Central Sulawesi Province, involving 235 nurse respondents from inpatient
rooms. The sampling technique used was purposive sampling to ensure a
representative sample of nurses providing direct patient care.
Data were collected
using standardized questionnaires that measured nurse burnout, patient safety
culture, and the quality of nursing care. The nurse burnout was assessed using
the Maslach Burnout Inventory (MBI), while the patient safety culture was evaluated
using the Hospital Survey on Patient Safety Culture (HSOPSC).
For data analysis,
the Pearson product-moment correlation test was used to examine the
relationships between variables. Additionally, multivariate modeling was
employed to identify the dominant factors influencing nursing care quality. The
results were considered statistically significant if the p-value was less than
0.05. The analysis revealed significant relationships between nurse burnout and
nursing care quality and between patient safety culture and nursing care
quality, with patient safety culture emerging as the dominant factor (β =
0.723).
RESULTS AND DISCUSSION
Univariate Analysis
Independent Variables
|
Variable |
Mean±SD |
CI 95% |
|
Nurse Burnout |
57.79±8.299 156.63±15.302 |
56.72-58.85 154.67-158.60 |
|
Patient Safety Culture |
Based on the table obtained, data in type B hospitals in
Central Sulawesi Province related to nurse burnout shows that the value is
(mean) 57.79 and standard deviation 8.299, with a 95% CI confidence interval
between 56.72-58.85. The patient safety
culture obtained a mean value of 156.63 and a standard deviation of 15.302,
with a 95% CI confidence interval between 154.67-158.60.
|
Dimension |
Mean±SD |
CI 95% |
|
Emotional Exhaustion |
12.39 ±7.188 |
11.47-13.32 |
|
Depersonalization |
4.26±4.167 |
3.73-4.80 |
|
Personal Accomplishment |
41.12±7.188 |
40.20-42,04 |
Based on the table obtained data in type B
hospitals of Central Sulawesi Province related to the dimensions of nurse
burnout in the Emotional Exhaustion domain showed that the mean value was 12.39, the standard value of
revision was 7.188, with
a 95% CI of 11.47-13.32.
Depersonalization obtained a mean value of 4.26, a standard value of revision of 4.167, with
a 95% CI of 3.73-4.80. Personal Accomplishment
obtained a mean value of 41.12, a standard value of revision 7.188, with
a 95% CI of 40.20-42.04.
|
Mean±SD |
CI 95% |
|
|
Teamwork Climate |
23.65±2.417 |
23.34-23,94 |
|
Safety climate |
32.00±4.430 |
31.43-32,57 |
|
Job Satisfaction |
22.59±2.852 |
22.22-22,95 |
|
Introduction to Stress |
10.88±3.344 |
10.45-11,31 |
|
Perception of Ward Management |
6.24±3.240 |
17.83-18,66 |
|
Perception of Hospital
Management |
17.84±3.615 |
17.37-18.30 |
|
Working Conditions |
31.43±4.420 |
30.86-32,00 |
Based on the table above, data obtained in type B hospitals in Central
Sulawesi Province related to the dimensions of patient safety culture in the
work climate domain showed that the mean value was
23.65, the standard value of revision was
2.417, with a 95% CI of 23.34-23.94. The patient safety climate obtained a mean
value of 32.00, a standard value of 4.430 division, with a 95% CI of 31.43-32.57. Job satisfaction obtained a mean value of
22.59, a standard value of 2.852, with a 95% CI of 22.22-22.95. The introduction of stress obtained a mean value of 10.88, a standard value of division of 3.344, with a 95% CI of 10.45-11.31. The perception of ward management obtained a mean value of 18.24, a standard value of division of 3,240, with a 95% CI of 17.83-18.66. The perception of hospital management obtained a mean value of 17.84, a standard value of revision of 3.615, with a 95% CI of 17.37-18.30. Working conditions obtained a mean value of 31.43, a standard value of revision of 4.420, with
a 95% CI of 30.86-32.00.
Dependent
Variables
|
Mean±SD |
CI 95% |
|
|
Quality of Nursing Care |
83.99±4.022 |
83.47-84.50 |
Based on the table, it is known that the quality of nursing care in
Type B Hospitals in Central Sulawesi Province shows a value of 83.99 and a
smaller standard deviation of 4,022 with a 95% CI confidence interval between 83.47-84.50.
Table 5. Distribution of Respondents Based on the Quality
Dimension of Nursing Care in Type B Hospitals of Central Sulawesi Province (n =
235)
|
Dimension |
Mean±SD |
CI 95% |
|
Patient Satisfaction |
10.62±1.416 |
10.44-10,80 |
|
Health Promotion |
9.58±1.546 |
9.38-9,78 |
|
Prevention of Complications |
10.51±1.141 |
10.36-10,66 |
|
Wellbeing &; Self-Care |
13.83±1.442 |
13.66-14.02 |
|
Functional Adaptations |
13.84±1.319 |
13.67-14.01 |
|
Askep Organization |
13.74±0.980 |
13.62-13,87 |
|
Responsibility & Thoroughness |
11.84±1.746 |
11.62-12,07 |
Based on the
table above, data obtained in type B hospitals in Central Sulawesi Province
related to the quality dimension of nursing care in the patient satisfaction
domain showed that the average or mean value was 10.61, the standard value of
revision was 1.416. with a 95% CI of 10.44-10.80. Health promotion obtained a
mean value of 9.58 and a
standard value of revision of 1.546. with a 95% CI of 9.38-9.78. Prevention of
complications obtained a mean value of 10.51 and a
standard value of revision of 1.141. with a 95% CI of 10.36-10.66. Well-being and self-care
obtained a mean value of 13.83, a standard value of revision 1.1442. with a 95%
CI of 13.66-14.02. Functional adaptation obtained a mean value of 13.84 and a standard value of revision 1.319. with
a 95% CI of 13.67-14.01. Nursing care organizations
obtained a mean value of 13.74 and a standard value of revision 0.980. with
a 95% CI of 13.62-13.87. Responsibility and accuracy
obtained a mean value of 11.84, which is a standard value of revision of 1.746. with
a 95% CI of 11.62-12.07.
Bivariate Analysis
Table 6. The Relationship of Nurse Burnout and
Patient Safety Culture to the Quality of Nursing Care (n=235)
|
Quality of Nursing Care |
||
|
p |
r |
|
|
Nurse Burnout |
0,000* |
-0,377 |
|
Patient Safety Culture |
0,000* |
0,716 |
*significant at p-value < 0.05
Based on the table, statistical test results
obtained a significant value in nurse burnout of 0.000 (p-value < 0.05), then H1 is
accepted, meaning there is a significant relationship between nurse burnout and
the quality of nursing care. The result of the correlation coefficient (r
count) -0.377 means that the correlation strength of the two variables is weak.
The results of statistical tests obtained
a significant value of 0.000 (p-value < 0.05), then H1 is
accepted, meaning there is a meaningful relationship between patient safety
culture and the quality of nursing care. The result of the correlation
coefficient (r count) of 0.716 means that the correlation strength of both variables
is strong.
Analysis Multivariate
|
Type |
B |
Beta |
r |
R2 |
Pvalue |
|
Constant |
65,139 |
|
0.816 0.666 0.000 |
||
|
Nurse Burnout |
- 0,189 |
-0,390 |
|||
|
Patient Safety Culture |
0,190 |
0,723 |
|||
Table 8. Final Modeling Results of Linear Regression Equations
Y=a+b1X1+b2X2
|
Quality
of Nursing Care = 65.139 - 0.189 nurse burnout + 0.190 patient
safety culture |
The
explanation of the regression equation model above can be explained as follows:
a. The
value obtained is 65,139, which means that if the variables of nurse burnout
and safety culture are assumed to be 0, then the quality value of nursing care
is 65,139.
b. The
regression coefficient value of the nurse burnout variable is negative at
-0.189, which means that if there is a 1% increase in the nurse burnout
variable, it will cause a decrease in the quality of nursing care by -0.189.
c. The
regression coefficient value of the patient safety culture variable is positive
at 0.190, which means that if there is a 1% increase in the patient safety
culture variable, it will cause an increase in the quality of nursing care by
0.190.
Based on the table, it is also
known that the correlation value r of 0.816 shows that the relationship between
nurse burnout and patient safety culture with the quality of nursing care is
very strong. In the test, the value coefficient (R-square) is 0.666. This means that there is
an ability to influence independent variables, namely nurse burnout and patient
safety culture, by 66.6%, with the dependent variable of nursing care quality. While the
remaining 33.4% were described as having a relationship with variables other
than independent variables outside this study.
Discussion
Nurse Burnout in
Type B Hospital in Central Sulawesi Province
The results showed that data in Type B
Hospital of Central Sulawesi Province related to nurse burnout showed that it
was in the sufficient category. Previous research has shown that the category
of burnout nurses can moderately affect the quality of nursing care. A study by
Cañadas-De la Fuente et al. It found
that nurse burnout was associated with decreased quality of care, length of
time of care, and patient satisfaction. In addition, burnout of nurses can lead
to a decrease in empathy and effective communication with patients
Burnout can occur because there is no
significant career development, either because of a lack of opportunities or
inappropriate education levels. Burnout can be said to be the result of a
mismatch between workers and their jobs; adjustments between education
and assigned tasks need to be considered. A low level of education, if faced with tasks and
workloads that exceed its capabilities, tends to increase stress and
burnout
Burnout is more common in young
individuals. This is because young individuals have less work experience than
older ones. As we age, generally,
individuals become more stable, more mature, and have a realistic outlook
on life. This makes older individuals able to withstand burnout
This is in line with stating that age is
related to the maturity and maturity of nurses. This shows that the age of
nurses can affect the quality of service, thinking
rationally and wisely, and controlling emotions. The longer a person
works, the more skilled and experienced he will be in dealing with problems in
his work. This is in line with research that there is a relationship between
the length of work and the performance of nurses in the inpatient room. The longer
the work, the
more it will affect the performance of the
nurse, including how to respond to problems encountered at work. Gender is not
a cause of burnout but is linked to factors such as role expectations and
employment rates. Different forms of burnout between men and women can be a
reflection of the different characteristics of the jobs they have, such as differences in the
intensity of relationships with clients, positions within institutions, and others
Hospitals are required to provide good
service to the community by utilizing their health facilities. These demands
can be a source of stress for nurses, especially if accompanied by high
workloads, limited resources, and a lack of organizational support.
In such conditions, nurses can experience burnout characterized by emotional
exhaustion, depersonalization, and decreased self-achievement. This can have an
impact on decreasing the quality of nursing care provided to patients. Thus,
nurse burnout needs to be a special concern in
order to support better health services. Burnout
in nurses needs to be managed,
considering burnout can affect performance, including a decrease in work
motivation and work performance
Safety Culture
in Type B Hospital of Central Sulawesi Province
Some research
suggests that a nurse's age can influence perceptions and behaviors related to
patient safety culture. Older nurses tend to have a better understanding of
patient safety and are more compliant with safety procedures. Gender can affect
patient safety culture. Female nurses report having a more positive perception
of patient safety culture than male nurses. The nurse
level can also affect patient safety culture. Nurses with higher education,
such as nurses who graduated from Ners, tend to have a better understanding of
the concept of patient safety. The length of a nurse's work experience can
affect the culture of patient safety. Nurses with longer work experience
generally have a better understanding and commitment to patient safety.
Patient safety culture is a major concern
in healthcare. Healthcare organizations such as hospitals with a positive
safety culture have the characteristics of being able to communicate with
mutual trust, share perceptions of the importance of safety, and trust
preventive measures. Research at Banda Aceh Hospital shows that efforts to
implement patient safety (patient safety) are in the category of not good. The
same research was also conducted by Bekasi City Hospital, which showed that nurses
practice good patient safety. This shows that the implementation of a patient
safety culture needs to be a concern and is important to ensure patient safety
Quality of
Nursing Care in Type B Hospital of Central Sulawesi Province.
More senior nurses tend to have better
experience and skills in providing caregiving, but younger nurses can be more
adaptive to technological developments and new procedures. Nurses with higher
levels of education can provide a more comprehensive education and critical
thinking. Nurses with longer work experience tend to have better clinical
competence and can provide more efficient care, but nurses with limited
experience can also provide new perspectives and innovative ideas. Meanwhile, male nurses are considered
more assertive and efficient in handling situations. Male and female nurses can
use different
approaches and communication styles when providing services. Their
level of therapeutic communication and professionalism in providing nursing
care is as good as that of female nurses.
Nurses who provide good nursing care
services to patients will make patients feel satisfied and will speed up the
healing process. Conversely, implementing nurses who are less than optimal in
providing nursing care services will make patients feel less satisfied and will
slow down the patient's recovery process. The existence of a reciprocal
relationship between the quality of nursing care and patient satisfaction
further proves that the relationship between the two is very close. This shows
that quality nursing care is related to the extent to which the physical,
psychosocial, and
extra care needs of patients are met, which will also affect the care
process undertaken by patients.
The Relationship
between Nurse Burnout and the Quality of Nursing Care in Type B Hospitals in
Central Sulawesi Province.
The results showed that nurse
burnout and the quality of nursing care were significantly related to the
quality of nursing care in the Type B Hospital of Central
Sulawesi Province. Shows the result of the correlation strength of the two weak
variables negative. With a negative value indicates that the two variables are
not in the same direction, which means that if burnout is weak, the quality of
nursing care increases. A study
conducted by Shi et al. (2023) on nurses in Canada revealed that nurse burnout
gave higher scores on measures of quality of care, including patient safety
and time effectiveness.
Burnout in nurses needs to be
managed, considering burnout can affect
the quality of nursing care services. Karasek and Theorell's
Demand-Control-Support model supports this phenomenon. According to this model,
burnout occurs when job demands are high while control over work and social
support is low. Nurses who are in this condition will be more prone to burnout,
which in turn affects the quality of their work, including nursing care
The results showed that, in general, nurses who were
the subjects of the study had sufficient levels of emotional exhaustion. This
means that the nurse feels emotionally exhausted in carrying out her duties and
responsibilities. While nurses in the study had relatively low rates of
depersonalization in general, a finding could be a positive consideration, as
it suggests that nurses still maintain a caring attitude and good emotional
engagement toward their patients. These results show that nurses have a good
level of personal achievement, which means that most nurses
feel that they can achieve their expected goals and achievements. Overall, the
results describe the profile of nurse burnout and where they experience it. In
this 3-dimensional study, the majority of burnout is still in the low to medium
stage, but it must be noted this is feared to show a trend where there is an
increase in the incidence of burnout from low to moderate for emotional
exhaustion if there is no improvement then this condition will develop further
towards increasing Cynicism
It is thus important for healthcare
institutions to understand and manage burnout among nurses. Some of the steps
that can be taken include providing emotional and professional support,
managing workloads, improving work control, and creating a positive work
environment
The Relationship
between Patient Safety Culture and the Quality of Nursing Care in Type B
Hospitals, Sulawesi Province, Central Sulawesi
The results of research at Type B Hospital
in Central Sulawesi Province showed a significant relationship between patient
safety culture and the quality of nursing care. With the value of the strength
of correlation, both variables are strongly positive. In line
with Smiley et al.
Patient safety culture is said to be
successful if all elements in the hospital apply patient safety culture in
their daily work
The Safety
Climate is greater than the teamwork climate dimension. Higher grade point
averages indicate that staff perceptions of the safety climate vary
significantly among nurses. This is in line with the research conducted that
staff perceptions of organizational commitment in prioritizing patient safety
are closely related to low medical incidence and error rates. Hospitals that
have a strong safety climate, where staff feel supported and motivated to
report misconduct, tend to have better safety cultures
The quality of nursing care provided by
nurses is very influential in an effort to maintain patient safety. The better
the nurse provides
nursing care services, the more capable the nurse is of implementing a patient safety culture. The
results of this study provide important information that improving patient
safety culture in the healthcare environment will have a positive impact on the
quality of nursing care provided. This can be a consideration for hospital
management or other health service institutions to increase the focus on
patient safety culture in an effort to improve the
quality of care services
The Variables
Associated Most Dominant with the Quality of Nursing Care in Type B Hospitals
in Central Sulawesi Province.
The results showed that the dominant
variable affecting the quality of nursing care was patient safety culture. In
line with the results of a cross-sectional study conducted by
nurses in Turkey, a significant positive correlation between patient safety
culture and the quality of nursing care was found
Improving the
culture of patient safety and maintaining nursing care services improves
the quality of nurse performance in the hospital. The quality of nursing care
provided by nurses is very influential in an effort to maintain patient safety.
The better the nurse in implementing and maintaining a culture of patient
safety, the more able the nurse is to provide quality nursing care services. The quality of nursing care is in accordance
with the reality and context in the hospital, and there
are six dimensions of assessment of the quality of nursing care, consisting of
patient satisfaction, health promotion, prevention of complications, well-being, and
self-care as well as functional readaptation and organization of nursing care
The results of
research on the quality dimension of nursing care show that the patient satisfaction
dimension. This shows that, in general, the assessment of
nurses' perceptions of the patient satisfaction
dimension has good results with nursing care provided at the hospital.
According to research by Safitri et al.
Health Promotion shows that hospitals are
quite good at providing health promotion to patients, but there is still room
for improvement. According to Safitri et al.
Prevention of complications shows that
hospitals are quite good at preventing
them. According to research by Safitri et al.
In these results, well-being &
self-care indicate that the hospital is very good at meeting the welfare and
self-care needs of patients. According to Safitri et al.
Functional adaptation shows that hospitals
are excellent at facilitating the functional adaptation of
patients. According to Safitri et al.
Responsibility and thoroughness show that
the hospital is good enough to
carry out its responsibilities and provide nursing care. According to
Safitri et al.
Overall, these data show that the quality
of nursing care in type B hospitals with several dimensions is very good, such
as well-being & self-care, functional adaptation, and nursing care
organization. However,
there is still room for improvement, especially in the dimension of health
promotion. Building a strong patient safety
culture is key to improving the quality of care provided to patients. The
variable that is most dominant in the quality of nursing care in
Type B Hospitals in Central Sulawesi Province is patient safety culture. This
shows that the quality of nursing care that runs in Type B Hospitals in Central
Sulawesi Province has a very close relationship with the implementation of
patient safety culture. A patient safety culture that is done correctly means
that reporting patient safety incidents is carried out correctly, and this is one of the important
things to maintain good performance, prudence, and service from nurses, which
will ultimately affect the quality of nursing care provided.
CONCLUSION
Burnout among nurses at Type B Hospital in
Central Sulawesi is moderate and requires attention to prevent worsening. The
hospital demonstrates a strong patient safety culture and good nursing care
quality, indicating effective service provision. A significant negative
relationship exists between nurse burnout and care quality: lower burnout leads
to higher care quality. Additionally, a significant positive relationship is
observed between patient safety culture and care quality: a better safety
culture results in higher care quality. Patient safety culture is the most
dominant factor affecting nursing care quality. Nurses are advised to enhance
stress management, proactively address burnout, strengthen patient safety
culture, and improve care competencies. Hospitals should focus on addressing
nurse burnout by developing coping strategies, reinforcing patient safety
culture, and ensuring adequate resources. Educational institutions should
integrate stress management training into curricula, emphasize the importance
of patient safety culture, and establish hospital partnerships. Researchers
should employ qualitative approaches, broaden the variable scope, and design
effective well-being programs for nurses. This research highlights the interconnectedness
of nurse burnout, patient safety culture, and nursing care quality.
Organizational support and effective communication are crucial for reducing
nurse burnout and fostering a positive patient safety culture. For hospital
administrators and policymakers, the study suggests strategies to improve
nursing care quality, such as implementing stress management programs and
creating supportive work environments. Enhancing patient safety culture through
training and policy changes can significantly improve patient outcomes and
satisfaction. Addressing both nurse burnout and patient safety culture is
essential for healthcare facilities to implement effective measures for overall
quality improvement in nursing care.
REFERENCES
Astuti, W.
(2023). Faktor yang mempengaruhi peran perawat dalam peningkatan
keselamatan pasien. 4, 709–718.
Brewer, K. C.,
Nguyen, J., Ziegler, H., Dodson, M., & Kurdian, S. (2023). Relationships
of organizational behavior/mission congruence with burnout, secondary
traumatic stress, and compassion satisfaction among nurses. Applied Nursing
Research, 73. https://doi.org/10.1016/j.apnr.2023.151700
Burnitt, E.,
Grealish, L. A., Crilly, J., May, K., & Ranse, J. (2024). Providing end of
life care in the emergency department: A hermeneutic phenomenological study. Australasian
Emergency Care. https://doi.org/10.1016/j.auec.2024.01.002
Camala, A.,
Marwati, T. A., & Akrom, A. (2022). Faktor-Faktor yang Berhubungan dengan
Kepuasan Pasien terhadap Pelayanan Keperawatan Ruang Rawat Jalan Rumah Sakit
Umum Daerah Bahteramas Provinsi Sulawesi Tenggara di Masa Pandemi Covid-19. Syntax
Literate ; Jurnal Ilmiah Indonesia, 7(2), 2443.
https://doi.org/10.36418/syntax-literate.v7i2.5593
Denning, M., Goh,
E. T., Scott, A., Martin, G., Markar, S., Flott, K., Mason, S., Przybylowicz,
J., Almonte, M., Clarke, J., Beatty, J. W., Chidambaram, S., Yalamanchili, S.,
Tan, B. Y. Q., Kanneganti, A., Sounderajah, V., Wells, M., Purkayastha, S., &
Kinross, J. (2020). What has been the impact of COVID-19 on safety culture? A
case study from a large metropolitan healthcare trust. International
Journal of Environmental Research and Public Health, 17(19), 1–12.
https://doi.org/10.3390/ijerph17197034
Elfina, Syam, B.,
& Nasution, S. Z. (2022). KEPEMIMPINAN KLINIS TERHADAP KUALITAS PELAYANAN
KEPERAWATAN. Journal of Telenursing (Joting), 4(2), 1–23.
https://doi.org/https://doi.org/10.31539/joting.v4i2.4233
Galleryzki, A.
R., Tutik, R., Haryati, S., & Bardah, D. (2023). Faktor-faktor yang
Mempengaruhi Sikap Perawat dalam Keselamatan Pasien : Systematic Review. 5(1),
16–26.
Hasan, N. N.,
Hama Rash, M. Q., & Mahmood, N. A. (2023). Burnout and resilience among
nurses during COVID-19 in Kirkuk city. Informatics in Medicine Unlocked,
43. https://doi.org/10.1016/j.imu.2023.101392
Heidari, S.,
Parizad, N., Goli, R., Mam-Qaderi, M., & Hassanpour, A. (2022). Job
satisfaction and its relationship with burnout among nurses working in
COVID-19 wards: A descriptive correlational study. Annals of Medicine and
Surgery, 82. https://doi.org/10.1016/j.amsu.2022.104591
Hetherington, D.,
Wilson, N. J., Dixon, K., & Murphy, G. (2024). Emergency department
Nurses’ narratives of burnout: Changing roles and boundaries. International
Emergency Nursing, 74. https://doi.org/10.1016/j.ienj.2024.101439
Hidayat, R.,
& Sureskiarti, E. (2020). Hubungan Beban Kerja Terhadap Kejenuhan (Burnout
) Kerja pada Perawat di Ruang Rawat Inap Rumah Sakit Umum Daerah Inche Abdoel
Moeis Samarinda. Borneo Student Research, 1(3), 2168–2173.
Hughes, R. V.
(Vickie), Hudson, K. W., Wright, E., Swoboda, S. M., Frangieh, J., &
D’Aoust, R. F. (2024). Cultivating Self-Compassion to Protect Nurses From
Burnout and Secondary Traumatic Stress. Nursing for Women’s Health, 28(2),
159–167. https://doi.org/10.1016/j.nwh.2024.01.003
Kadir, L. P.,
Syukur, S. B., & Syamsuddin, F. (2023). Hubungan Kualitas Pelayanan
Keperawatan Dengan Kepuasan Pasien Di Rumah Sakit Umum Daerah Tombulilato. Jurnal
Riset Rumpun Ilmu Kesehatan (JURRIKES), 2(1), 159–171.
Kakemam, E.,
Chegini, Z., Rouhi, A., Ahmadi, F., & Majidi, S. (2021). Burnout and its
relationship to self-reported quality of patient care and adverse events
during COVID-19: A cross-sectional online survey among nurses. Journal of
Nursing Management, 29(7), 1974–1982.
https://doi.org/10.1111/jonm.13359
Kim, D. K.,
Scott, P., Poghosyan, L., & Martsolf, G. R. (2024). Burnout, job
satisfaction, and turnover intention among primary care nurse practitioners
with their own patient panels. Nursing Outlook, 72(4).
https://doi.org/10.1016/j.outlook.2024.102190
Kim, N. Y., &
Jeong, S. Y. (2021). Perioperative patient safety management activities: A
modified theory of planned behavior. PLoS ONE, 16(6 June),
384–392. https://doi.org/10.1371/journal.pone.0252648
Kulakaç, N.,
& Uzun, S. (2023). The Effect of Burnout and Moral Sensitivity Levels of
Surgical Unit Nurses on Job Satisfaction. Journal of Perianesthesia Nursing,
38(5), 768–772. https://doi.org/10.1016/j.jopan.2023.01.012
Kuraesin, D.,
Mutiara, R., Kusumapradja, R., & Unggul, U. E. (2023). RUANG RAWAT INAP.
Labrague, L. J.
(2024). Emergency room nurses’ caring ability and its relationship with
patient safety outcomes: A cross-sectional study. International Emergency
Nursing, 72. https://doi.org/10.1016/j.ienj.2023.101389
Lee, S. E., Seo,
J. kyung, & Squires, A. (2024). Voice, silence, perceived impact,
psychological safety, and burnout among nurses: A structural equation modeling
analysis. International Journal of Nursing Studies, 151.
https://doi.org/10.1016/j.ijnurstu.2023.104669
Lestari, R.,
Setyawan, F. E. B., Supriyanto, S., & Ernawaty, E. (2020). Understanding
patient satisfaction and loyalty in public and private primary health care. Journal
of Public Health Research, 9(2), 140–143.
https://doi.org/10.4081/jphr.2020.1823
Lusiyana, A.,
Handiyani, H., & Pujasari, H. (2021). The Relationship Between Case
Manager Competence and Nurse Burnout in Indonesia. KnE Life Sciences, 2021,
953–968. https://doi.org/10.18502/kls.v6i1.8772
Mahmoudi, S.,
Barkhordari-Sharifabad, M., Pishgooie, A. H., Atashzadeh-Shoorideh, F., &
Lotfi, Z. (2020). Burnout among Iranian nurses: a national survey. BMC
Nursing, 19(1), 1–9. https://doi.org/10.1186/s12912-020-00461-7
Majannang, E. A.
D., Kadir, A., & Hamsinah, S. (2021). Hubungan Motivasi Dan Masa Kerja
Terhadap Kinerja Perawat Di Ruang Rawat Inap Rumah Sakit Umum Daerah Haji
Makassar. Jurnal Ilmiah Mahasiswa & Penelitian Keperawatan, 1(27),
90157.
Mirza, M. N.,
Rukun, P., & Luhur, A. (2022). Exploratory Study of Burnout Incidence on
Inpatient Nurses in Kaliwungu District , Kudus Regency Studi Eksplorasi
Kejadian Burnout pada Perawat Rawat Inap di Kecamatan Kaliwungu Kabupaten
Kudus LATAR BELAKANG Burnout merupakan masalah yang sering muncul p. Menara
Journal of Health Science, 196–204.
Monsalve C, San
Luis C, Gómez J, Albendín L, Aguayo R, & Cañadas G. (2018). Burnout
syndrome and its prevalence in primary care nursing: a systematic review and
meta-analysis. BMC Family Practice, 1–7.
Muir, K. J.,
Keim-Malpass, J., & LeBaron, V. T. (2022). “You have to ask yourself when
you’ve had enough”: An ethnography of multi-level nurse burnout cultural
impacts in the emergency department. SSM - Qualitative Research in Health,
2. https://doi.org/10.1016/j.ssmqr.2022.100111
Nikpour, J.,
& Carthon, J. M. B. (2023). Characteristics, work environments, and rates
of burnout and job dissatisfaction among registered nurses in primary care. Nursing
Outlook, 71(4). https://doi.org/10.1016/j.outlook.2023.101988
Ningrum, E.,
Evans, S., & Soh, S. E. (2019). Validation of the Indonesian version of
the Safety Attitudes Questionnaire: A Rasch analysis. PLoS ONE, 14(4),
1–11. https://doi.org/10.1371/journal.pone.0215128
Owuor, R. A.,
Mutungi, K., Anyango, R., & Mwita, C. C. (2020). Prevalence of burnout
among nurses in sub-saharan africa: A systematic review. JBI Evidence
Synthesis, 18(6), 1189–1207.
https://doi.org/10.11124/JBISRIR-D-19-00170
Paramitha, D. S.,
Kusumawati, N., Hidayat, R., Al Ashri, A., Tauhidah, N. I., Nurman, M.,
Rahayu, S. F., Ningsih, N. F., Amaliah, N., & Sinthania, D. (2021). Nilai
Esensial Dalam Praktik Keperawatan. Penerbit Insania.
Putra, K. R.,
Sutadi, H., Setyowati, S., & Hariyati, R. T. S. (2021). The impact of
nurse manager caring behaviors and work environment on burnout syndrome among
nurses. Kontakt, 23(2), 90–96.
https://doi.org/10.32725/kont.2021.019
Roth, C., Berger,
S., Krug, K., Mahler, C., & Wensing, M. (2021). Internationally trained
nurses and host nurses’ perceptions of safety culture, work-life-balance,
burnout, and job demand during workplace integration: a cross-sectional study.
BMC Nursing, 20(1), 1–15.
https://doi.org/10.1186/s12912-021-00581-8
Sabrina, A.,
Tusrini, W., & Dwi Tamara, M. (2023). Faktor-Faktor yang Berhubungan
dengan Kejadian Burnout pada Perawat di Rumah Sakit (Literature Review). Jurnal
Sehat Masada, 17(1), 49–57. https://doi.org/10.38037/jsm.v17i1.409
Singal, E. M.,
Manampiring, A. E., & Nelwan, J. E. (2021). Analisis Faktor-Faktor Yang
Berhubungan Dengan Stres Kerja Pada Pegawai Rumah Sakit Mata Provinsi Sulawesi
Utara. Sam Ratulangi Journal of Public Health, 1(2), 040.
https://doi.org/10.35801/srjoph.v1i2.31988
Smiley, R., Reid,
M., & Martin, B. (2024). The Registered Nurse Workforce: Examining Nurses’
Practice Patterns, Workloads, and Burnout by Race and Ethnicity. Journal of
Nursing Regulation, 15(1), 65–79.
https://doi.org/10.1016/S2155-8256(24)00030-9
Sujanah, W.,
Pratiwi, A. D., & Akifah, A. (2021). Faktor-Faktor Yang Berhubungan Dengan
Burnout Syndrome Pada Perawat Di Rsud Bahteramas, Sulawesi Tenggara. Jurnal
Kesehatan Masyarakat (Undip), 9(5), 675–680.
https://doi.org/10.14710/jkm.v9i5.30697
Sureskiarti, E.,
Masnina, R., Wijayanti, T., Zulaikha, F., Praja, A., & Husnia. (2021).
Nursing care to improve the quality of nursing services. Indonesian Journal
of Global Health Research, 3(2), 229–236.
Taskin, O.,
Disel, N. R., & Yilmaz, M. (2024). Amidst the clamor: Effects of emergency
department noise on Physicians’ health and attention. American Journal of
Emergency Medicine, 76, 87–92.
https://doi.org/10.1016/j.ajem.2023.11.007
Tucker, C. M.,
Jaffe, R., & Goldberg, A. (2023). Supporting a culture of patient safety:
Resident-led patient safety event reviews in a pathology residency training
program. Academic Pathology, 10(1).
https://doi.org/10.1016/j.acpath.2023.100069
Wirati, N. P. R.,
Wati, N. M. N., & Saraswati, N. L. G. I. (2020). Hubungan Burnout Dengan
Motivasi Kerja Perawat Pelaksana. Jurnal Kepemimpinan Dan Manajemen
Keperawatan, 3(1), 8. https://doi.org/10.32584/jkmk.v3i1.468
Woo, T., Ho, R.,
Tang, A., & Tam, W. (2020). Global prevalence of burnout symptoms among
nurses: A systematic review and meta-analysis. Journal of Psychiatric
Research, 123(August 2019), 9–20.
https://doi.org/10.1016/j.jpsychires.2019.12.015
World Health
Organization. (2020). Quality health services.
Xue, L., Zhong,
Q., Xu, N., Zheng, Y., & Liu, Y. (2024). Investigation in image quality
and immediate patient safety using pre-dual-flow injection for low-contrast
dose spectral pulmonary artery CT angiography. European Journal of
Radiology Open, 12. https://doi.org/10.1016/j.ejro.2024.100571
Zimmermann, N.,
Küng, K., Sereika, S. M., Engberg, S., Sexton, B., & Schwendimann, R.
(2013). Assessing the safety attitudes questionnaire (SAQ), German language
version in Swiss university hospitals - A validation study. BMC Health
Services Research, 13(1). https://doi.org/10.1186/1472-6963-13-347
Zulkhulaifah, S.
A., Pasinringi, S. A., & Sari, N. (2022). Persepsi Kepuasan Pasien
Terhadap Kualitas Pelayanan Keperawatan Di Rawat Inap Tahun 2022. Hasanuddin
Journal of Public Health, 3(3), 246–256.
https://doi.org/10.30597/hjph.v3i3.23370
|
Copyright Holder: Fitria Dewi Susanti1,Sri Andarini2, Kuswantoro Rusca Putra3 (2024) |
|
First Publication
Right: Journal of Health Science |
|
This article is licensed
under:
|
