Mediating roles of patient safety knowledge and motivation in the relationship between safety climate and nurses’ patient safety behaviors: a structural equation modeling analysis

BACKGROUND: Few studies have examined the relationship between patient safety climate and two forms of patient safety behavior (i.e., safety compliance and safety participation) among nurses. Better understanding of factors contributing to nurses’ safety behaviors could enhance patient safety. Therefore, this study aimed to examine the effect of patient safety climate on nurses’ patient safety behavior and to explore whether patient safety knowledge and motivation mediate this relationship. METHODS: This correlational, cross-sectional study used survey data from 1,053 staff nurses working at a general hospital located in a metropolitan area of South Korea. Structural equation modeling was employed to test a hypothesized multiple mediation model that was guided by Griffin and Neal’s model of safety performance. RESULTS: The results indicated that patient safety climate was directly related to both patient safety compliance behavior (β = 0.27, p < 0.001) and patient safety participation behavior (β = 0.25, p < 0.001). Concerning indirect effects, patient safety climate was associated with patient safety compliance behavior through both patient safety knowledge (β = 0.26, p < 0.001) and patient safety motivation (β = 0.04, p = 0.038), whereas patient safety climate was related to patient safety participation behavior only through patient safety knowledge (β = 0.27, p < 0.001) and not through patient safety motivation (β = 0.00, p = 0.985). CONCLUSION: Based on this study’s findings, building an organizational climate focused on patient safety is vital for improving nurses’ patient safety behavior. Improving an organization’s patient safety climate could promote both safety knowledge and motivation in nurses and thereby potentially enhance their patient safety behavior. Hence, healthcare organizations should implement practical interventions to improve their patient safety climate. Also, nursing management interventions designed to transfer patient safety knowledge to nurses would be particularly effective in improving their safety behavior.