Volume 28, Issue 4 (Fall 2020)                   Avicenna J Nurs Midwifery Care 2020, 28(4): 74-83 | Back to browse issues page

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Mohammadi Z. Relationship Between Nursing Communication Characteristics and Patient Safety Culture at Educational Hospitals in Sanandaj City. Avicenna J Nurs Midwifery Care 2020; 28 (4) :74-83
URL: http://nmj.umsha.ac.ir/article-1-2213-en.html
Faculty of Nursing and Midwifery, Medical Sciences University of Kurdistan. Sanandaj, Iran , zahra.mohammadi1116@gmail.com
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✅ Based on the results of the research, the status of the patient safety culture and communication skills was moderate. To improve the patient's safety status, nurses’ communication skills should be improved. This is possible during the nurse’s formal education or in-service training.

Extended Abstract:   (894 Views)

Hospitals are one of the most important institutions providing health services that should provide a safe environment for their patients and prevent accidents for them [1]. The first goal in a medical center is to prevent harm to the patient and endanger his safety and provide health services. Studies show that one-fifth of the population is exposed to medical errors and mistakes, and as a result, millions of people may die or avoid unavoidable medical injuries as a result of these errors. Therefore, improving patient safety is a common international priority [2]. Patient safety is one of the vital components and quality indicators of health-related care [3].
Patient safety means preventing the damage caused by errors while performing the task due to negligence or those actions that reduce the risk of adverse events related to medical error [9, 8]. The current study investigated the relationship between nurses' communication features and patient safety culture in educational hospitals in Sanandaj city, Iran.


Materials and Methods

This correlational study was performed on 278 nurses working in educational hospitals in Sanandaj, Iran. The standard safety culture questionnaire made by Barton J.'s quality and health care research and communication skills agency was used. The standard questionnaire used was in two sections. Data analysis was conducted using SPSS 19. In the descriptive statistics section, mean and standard deviation, and in the inferential statistics, correlation tests, Mann-Whitney, Kruskal-Wallis, and linear regression were used.



The mean of total positive responses to 12 dimensions of patient safety culture was 59.11%. The negative response was 22.07% and the neutral responses were 17.94%. These results indicated an acceptable status of safety culture in the studied hospitals. The average of communication skills among nurses in Sanandaj was 66.98±9.57 (maximum score is 90). The inferential analysis showed that there is a significant relationship between variables such as age, work experience, marital status, educational level, and type of employment with two main variables (communication skills and patient safety culture). The results of linear regression showed that the components of communication skills (verbal, listening, and feedback) have a positive and significant effect on improving the patient's safety culture. These components may explain 55.2% of the variation of the dependent variable (the patient's safety culture).
Table 1. Frequency distribution of study participants
Variable Category N %
Man 98 35.25
Female 180 64.75
Marital status
Single 101 36.33
Married 177 63.67
30 ˂ 83 29.85
4030 152 54.67
40 ˃ 43 15.48
Work experience 8 ˂ 159 57.19
8-18 years 78 28.05
18˃ 41 14.76
Level of Education
Bachelor 218 78.41
Master and higher 60 21.59
Employment relationship Official 38 13.66
Trial 48 17.26
Project 68 24.46
Contractual 29 10.43
Company 53 19.06
Design 42 15.13
Table 2. Mean and standard deviation of patient safety culture and communication skills of nurses
Variables Aspects M SD
Safety culture Frequency of incident reporting 2.87 0.68
General understanding of patient safety 3.46 0.71
Actions of the head of the unit in the direction of patient safety 3.82 0.61
Organizational learning and continuous improvement 3.98 0.72
Teamwork within the unit 3.85 0.62
Open communication channel 3.68 0.71
Communication and providing feedback on errors 4.01 0.49
Non-punitive responses to errors 3.12 0.52
Employee issues 2.25 0.61
Support your manager 3.88 0.72
Teamwork among hospital units 4.01 0.59
Exchange of information 2.85 0.53
Patient safety culture 3.48 0.62
Communication skills Verbal 23.59 2.87
Heard 21.17 3.28
Feedback 22.22 3.42
Table 3. Relationship between demographic variables with the two main research variables (communication skills and patient safety culture)
Demographic variables
Categories Frequency Type of test The dependent variable
Communication skills Safety culture
30 ˂ 83 Spearman correlation r=0.28 r=0.37
4030 152
40 ˃ 43 P=0.015 P=0.015
Work experience
8 ˂ 159 Spearman correlation r=0.28 r=0.37
8-18 years 78 P=0.015 P=0.015
18˃ 41
Male 98 Mann–Whitney 2.01± 25.88 2.28± 19.16
Female 180 1.25± 26.14 2.25± 18.15
P=0.213 P=0.315
Marital status
Single 101 Mann–Whitney 1.25± 25.75 2.11± 18.24
Married 177 1.36± 28.13 1.24± 19.52
P=0.001 P=0.213
Level of Education
Bachelor 218 Mann–Whitney 2.11± 24.27 2.18± 18.25
Master and higher 60 2.52± 27.85 1.87± 21.17
P=0.010 P=0.001
Type of employment Official 38 Kruskal-Wallis 1.25± 23.14 2.58± 28.14
Trial 48 2.42± 22.14 2.04± 26.41
Project 68 2.21± 21.12 2.52± 27.65
Contractual 29 2.12± 19.14 2.01± 24.25
Company 53 2.12± 18.52 2.42± 22.14
Design 42 2.14± 17.15 2.24± 19.52
P=0.001 P=0.001
Table 4. The effect of communication skills component on patient safety culture
Predictive variables B Std. Error Beta t Sig. R R2 R2Ad
- Verbal skills 2.82 0.505 0.261 **5.592 0.001      
- Listening skills 3.74 0.604 0.301 **6.203 0.001 0.772 0.552 0.559
- Feedback skills 2.435 0.580 0.216 **4.197 0.001      
F: 24.107Sig: 0.000Constant: 15.949


Initially, patient safety culture status (HSOPSC), which is one of the common tools for examining patient safety culture in hospitals, was used. The overall mean of patient safety culture was (3.48 ± 0.62) which indicates the average of patient safety culture. The results of this section are consistent with the studies of Rezapoor et al. [34] and Mahfoozpour et al. [35] who in their research estimated the status of patient safety culture in teaching hospitals of Tehran University of Medical Sciences and Shahid Beheshti at a moderate level. This finding indicates that due to the sensitivity of the issue, there is an urgent need to improve the patient's safety culture in the hospital. Therefore, in order to strengthen the patient's safety culture, the three factors of blame, fear and silence that are destructive to any organization must be eradicated from the workplace. Errors should not be hidden but should be learned and used as a first step to eliminate the damage caused by them and improve patient safety [36].
Also, in examining the dimensions of 12 patient safety cultures, the most positive response of organizational learning and continuous improvement (84.82%) of the results of this part of the study with the findings of Sharifi et al. in Mazandaran hospitals [37] and non-punitive responses to errors ( 19/14) received the lowest positive response is consistent with the findings of Yaghoubi et al. in Sabzevar hospitals [38].
In addition, the results of inferential analysis showed that the variable of communication skills with their demographic characteristics, ie age, marital status, work experience, education level and type of employment has a positive and significant relationship with the study of Wang et al. in China [29] and Mirhaghjou et al. in Kerman Province, Iran [43], and contradicted Rezaei's studies on the lack of association between age groups and work experience with the status of safety culture [33].
Also, in examining the relationship between demographic characteristics and culture, it was shown that there is a positive and significant relationship with the variables of age, marital status, work experience, level of education and type of employment. The results of this section are consistent with studies by Sorra and Nieva at the International Agency for Research and Health Quality [30]. In analyzing this finding, it can be said that, considering the importance of the patient's safety culture, the role of demographic factors should be considered in order to have a significant effect on its improvement.



Based on the results of the research, the status of the patient safety culture and communication skills was moderate. To improve the patient's safety status, nurses’ communication skills should be improved. This is possible during the nurse’s formal education or in-service training.



The support of Kurdistan University of Medical Sciences in conducting this research is hereby thanked and appreciated. This article is an excerpt from a research project with ethics code IR.MUK.REC.1398.199.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Nursing
Received: 2020/07/20 | Accepted: 2020/10/11 | Published: 2020/11/23

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