Patient Safety Culture, Missed Nursing Care, and Adverse Events in University Hospitals: A Cross-Sectional Study

Background: Patient safety culture, which reflects fundamental assumptions and actions related to patient safety, remains unchanged after accreditation. Missed nursing care is prevalent in university hospitals and affects the occurrence of adverse events. This study aims to determine the effect of patient safety culture on missed nursing care and adverse events as perceived by nurses at university hospitals. Materials and Methods: This cross-sectional study was conducted using an online survey at six university hospitals in Indonesia from September to November 2021. The survey included the Safety Attitude Questionnaire (SAQ), the missed nursing care instrument by the international RN4Cast consortium, and the adverse event instrument by the International Hospital Outcomes Research Consortium. A total of 330 nurses completed the survey. Results: A total of 330 nurses participated in this study, resulting in an 89% response rate. The findings show a significant correlation between safety culture and missed nursing care (r = 0.153; p < 0.001) and between safety culture and adverse events (r = 0.001 p < 0.001). The positive coefficient value indicates that a better safety culture was associated with reduced missed nursing care. Additionally, there was a significant relationship between missed nursing care and adverse events (r = 0.146, p < 0.001), indicating that a higher incidence of missed nursing care leads to more adverse events. Conclusions: This study indicates that modification on patient safety culture correlates with changes in missed nursing care and adverse events as quality of nursing services.