8/11/2019 Development of a Self-Report Instrument to Measure
Patient Safety Attitudes, Skills, And Knowledge
1/5
Profession and Socie
Development of a Self-Report Instrument to MeasurePatient Safety
Attitudes, Skills, and KnowledgeRebecca Schnall, Patricia Stone,
Leanne Currie, Karen Desjardins, Rita Marie John, Suzanne
Bakken
Purpose: To describe the development and psychometric testing of
the Patient Safety Atti-tudes, Skills and Knowledge Scale
(PS-ASK).
Methods: Content validity of a 35-item instrument was
established by a panel of experts. Theinstrument was pilot tested
on 285 nursing students. Principal components analysis (PCA)with
varimax rotation was conducted, and Cronbachs alphas were examined.
Pairedsamples t-tests were used to show responsiveness of the
scales pre- and post-patient safetycurriculum.
Results: The final instrument consists of 26 items and three
separate scales: attitudes, skills,and knowledge. The attitudes and
skills scales each had a three-factor solution. The knowl-edge
items had a one-factor solution. Both skills and knowledge were
significantly increased
at Time 2 (p.05) 6.71 (.7) wedeleted. The sample for the PCA
consisted of 285 of 32nursing students in year 1 of the combined
BS-MS APprogram in 2006 and 2007 prior to RN licensure. The sample
for the responsiveness analysis (paired sample t-testwas a subset
(N=145) of the 200708 class that complet
the tool at the beginning and end of the patient-safety
curiculum approximately 6 months apart.
Findings
The PCA of attitude items resulted in a three-factonine-item
solution (Table 1) that explained a total of 45.9of the variance.
Four items were eliminated because inconsistencies with our
curriculum; two additional itemwere deleted because of low factor
loading. Cronbachs aphas for the factor scales were Error Detection
(four items=.57; Time Investment (two items), =.76, and Creatina
Culture of Safety (three items), =.49. Creating a cuture of safety
was the only factor with a significant positichange in the
responsiveness analysis.
392 Fourth Quarter 2008 Journal of Nursing Scholarship
8/11/2019 Development of a Self-Report Instrument to Measure
Patient Safety Attitudes, Skills, And Knowledge
3/5
Patient Safety Self Assessme
Table 2. Skills Item Means and Factor Loadings (N=282)
Error Decision support Threats to
analysis technology patient safet
6 items 3 Items 4 Items
(1=not competent to 5=expert) Mean (SD) =. 84 =. 82 =.71
Participating as a team member of a Failure Mode & effect
analysis 1.29 (0.73) .74
Interpreting aggregate error report data 1.35 (0.75) .73
Participating as a team member of a root- cause analysis 1.24
(0.65) .70
Accurately entering an error report 1.43 (0.85) .64
Participating in morbidity and morality conferences 1.39 (0.82)
.60
Supporting and advising a peer who must decide how to respond to
an error 2.33 (1.16) .56
Using computer-based provider order entry 1.22 (0.66) .82
Using computer-based falls risk assessment 1.19 (0.55) .77
Using barcode medication administration system 1.28 (0.74)
.77
Using antimicrobial handwashing substances 3.93 (1.10) .80
Using pressure relieving bedding materials to prevent pressure
ulcers 2.23 (1.23) .68
Asking patients to recall and restate what they have been told
during the 2.08 (1.16) .53
informed consent processDisclosing an error to a patient and/or
family member 1.65 (0.91) .43
Test means (SD)N=144 1.47 (0.59) 1.20 (0.51) 2.31 (1.02)
Retest means (SD) 2.24 (0.69) 2.66 (0.87) 3.15 (0.64)
Paired samples,ttest, test/retest (p) 11.29 (
8/11/2019 Development of a Self-Report Instrument to Measure
Patient Safety Attitudes, Skills, And Knowledge
4/5
Patient Safety Self Assessment
analyses in other samples (e.g., nurses, physicians,
alliedhealth professionals) are needed.
Conclusions
These analyses provide preliminary evidence for theconstruct
validity and internal consistency reliability of the
skills and knowledge subscales of the PS-ASK in a sampleof
pre-licensure students in the first year of a combined BS-MS APN
program. Significant differences in scores on theskills and
knowledge scales before and after completion ofthe patient-safety
curriculum show the responsiveness of thescales. Refinement of the
attitudes scale is needed and com-parisons with other types of
measures of clinicians patientsafety competencies (e.g.,
observation) and knowledge arewarranted.
As nursing-school leaders accept the charge to incorpo-rate
patient safety into their curriculum, assessment of theeffect of
these educational programs will be needed. This
scale, after further development, might provide a useful toolfor
that assessment.
Clinical Resources
Agency for Healthcare Research and Quality(AHRQ) on Medical
Errors and Patient Safety.http://www.ahrq.gov/qual/
errorsix.htm/?id=19714
The IOM Health Care Quality Initiative.
http://www.iom.edu/CMS/8089.aspx
VA National Center for Patient Safety.
http://www.va.gov/ncps/
References
Benbassat, J., Pilpel, D.,& Schor, R. (2001). Physicians
attitudes towalitigation and defensive practice: Development of a
scale. BehavioMedicine,27(2), 5260.
Colla, J., Bracken, A., Kinney, L.,& Weeks, W.(2005).
Measuring patiesafety climate: A review of surveys. Quality and
Safety in Health Ca14, 364366.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J.,
Johnson, Mitchell, P., et al. (2007). Quality andsafety education
for nurses. Nuing Outlook,55, 122131.
Kohn, L., Corrigan, J., & Donaldson, M.S. (2000). To err is
human: Buiing a safer health system. Washington, DC: Institute of
Medicine, Ntional Academy Press.
Ladden, M.D., Bednash, G., Stevens, D.P., & Moore, G.T.
(200Educating interprofessional learners for quality, safety and
stems improvement. Journal of Interprofessinal Care, 20(5),
49505.
Madigosky, W.S., Headrick, L.A., Nelson, K., Cox, K.R&
Anderson, T. (2006). Changing and sustaining mecal students
knowledge, skills, and attitudes about patiesafety and medical
fallibility. Academic Medicine, 81(1), 9101.
Modak, I., Sexton, J.B., Lux, T.R., Helmreich, R.L., &
Thomas, E(2007). Measuring safety culture in the ambulatory
setting: The safeattitudes questionnaireambulatory version.Journal
of General InternMedicine,22(1), 15.
Page, A. (2004). Keeping patients safe: Transforming twork
environment of nurses. Washington, DC: Institute Medicine.
Reason, J.T.(2000). Human error: models and management.British
Meical Journal,320(7237), 768770.
Sexton, J.B., Helmreich, R.L., Neilands, T.B., Rowan, K., Vella,
KBoyden, J.,et al.(2006). The Safety Attitudes Questionnaire:
Psychomtric properties, benchmarking data, and emerging research.
BMC HeaServices Research,6, 44.
Shojania, K.G., Duncan, B.W., McDonald, K.M., & Wachter,
R.(2001). Making health care safer: A critical analysis of patient
safepractices(Vol.43). Rockville, MD: AHRQ.
394 Fourth Quarter 2008 Journal of Nursing Scholarship
