title: The effects of contextual and structural factors on patient safety in nursing units.
abstract: BACKGROUND
  Because of limited research on patient safety from a macrolevel perspective, our understanding of how to reduce the risk of system failures that impact patient safety outcomes in Taiwanese healthcare organizations is limited.
  
  
  OBJECTIVE
  We conducted this study to explore the relationships between macrolevel factors and patient safety outcomes.
  
  
  METHODS
  Structural contingency theory was used as the framework for the study. A cross-sectional design was used, and data were collected from self-administered questionnaires. Head nurses and registered nurses working in 64 in-patient nursing units at three hospitals participated in the study. A tailored design method was used for data collation, and the data collection lasted 3 weeks during the winter of 2010. Data were aggregated from the individual to the unit level, and path analysis was used to examine the hypothesized model.
  
  
  RESULTS
  Sixty-two head nurses (96.8%) and 977 staff nurses (72%) completed and returned the questionnaire. Eta-squared coefficient (η), interitem consistency (rwg), and F ratio results showed that data at the individual level are appropriate for aggregating to the unit level. These findings show that nursing units with high degrees of professional autonomy, comparatively higher proportions of nursing experts, and relatively large unit sizes tend to have higher rates of medication errors. In addition, we found high degrees of unit technology associated with higher rates of medication errors and patient falls.
  
  
  CONCLUSIONS
  These findings suggest a link between macrolevel factors and patient safety outcomes. This study shows that redesigning continuing education programs encourages nurses to participate in patient safety training and understand the nursing unit characteristics that enhance patient safety outcomes to improve the patient safety of nursing units.
authors: Department of Nursing, Chang Gung University of Science and Technology, ChiaYi Campus. cchung@gw.cgust.edu.tw
authors: Chang-Chiao
authors: CC
authors: Hung
authors: Su-Chen
authors: SC
authors: Hsu
authors: Lai-Liang
authors: LL
authors: Lee
authors: Chiu-Mien
authors: CM
authors: Huang
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009741:Nursing Staff, Hospital; D061214:Patient Safety; D013624:Taiwan