Systematic Literature Review: Nurses and Patient Safety

MEDIC NUTRICIA 2023, Vol. 1, No.
3
31-40
Jurnal Ilmu Kesehatan Prefix DOI 10.5455/mnj.v1i2.644
ISSN : 3025-8855
SYSTEMATIC LITERATURE REVIEW: NURSES AND PATIENT SAFETY
Iman Nurjaman1*, Ina Saparlina2

1
Faculty of Health Science and Technology, Jenderal Achmad Yani University,
Cimahi, West Java, Indonesia
2
College of Teacher Training and Education, Garut, West Java, Indonesia
*e-mail imannurjaman16@gmail.com
Abstract
Background: One of the most important issues in the world is patient safety, especially when
patients are in hospitals. The role of nurses as the most dominant health workers in
maintaining patient safety in hospitals is very important because they directly meet patients
every day. Therefore, it is important to determine the extent of the nurse's role in preventing
incidents that threaten patient safety. Aim: This study was to find out the findings of
previous research on how nurses maintain patient safety in hospitals. Design: Systematic
Literature Review. Method: Is a literature review, using electronic databases from Scopus,
Google Scholar, Pubmed, and Grey literature (National Library of Indonesia) with keywords:
patient safety, compliance, and implementation of patient safety by nurses. The study met the
following criteria: implementation of patient safety carried out by nurses; research design is
qualitative or quantitative; quantitative or qualitative methods; and empirical papers
published in English or Indonesian between 2018-2023. The collected articles consist of
thirteen narratively arranged papers. Results: It found two papers on health policy, two
papers on handover, one paper on risk reduction for falls, one paper on the use of surgical
safety checklists, three papers on reducing the risk of infection, and four papers on
implementing patient safety. This literature review found that nurses have made various
innovations to ensure patient safety in hospitals. Conclusion: Patient safety is a major factor
in patient satisfaction during their stay in the hospital, and this innovation can be an example
for other hospitals to improve the quality of their services.
Kata kunci: Nurse; Patient Safety
Abstrak
Latar Belakang: Salah satu masalah yang paling penting di dunia adalah
keselamatan pasien, terutama ketika pasien berada di rumah sakit. Peran perawat
sebagai tenaga kesehatan yang paling dominan dalam menjaga keselamatan pasien
di rumah sakit sangat penting karena mereka langsung bertemu pasien setiap hari.
Oleh karena itu, penting untuk menentukan sejauh mana peran perawat dalam
mencegah insiden yang mengancam keselamatan pasien. Tujuan: Penelitian ini
adalah untuk mengetahui temuan penelitian sebelumnya tentang bagaimana
perawat menjaga keselamatan pasien di rumah sakit. Desain: Systematic Literature
Review. Metode: Adalah peninjauan literatur, dengan menggunakan basis data
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elektronik dari Scopus, Google Scholar, Pubmed, dan Grey literature (National
Library of Indonesia) dengan kata kunci: keselamatan pasien, kepatuhan, dan
implementasi keselamatan pasien oleh perawat. Penelitian ini memenuhi kriteria
berikut: implementasi keselamatan pasien yang dilakukan oleh perawat; rancangan
penelitian adalah kualitatif atau kuantitatif; metode kuantitatif atau kualitatif; dan
makalah empiris yang dipublikasikan dalam bahasa Inggris atau Indonesia antara
tahun 2018-2023. Artikel yang dikumpulkan terdiri dari Tiga belas makalah yang
disusun secara naratif. Hasil: Ditemukan dua makalah mengenai kebijakan
kesehatan, dua makalah mengenai handover, satu makalah mengenai pengurangan
risiko jatuh, satu makalah mengenai penggunaan surgical safety check list, tiga
makalah mengenai pengurangan risiko infeksi dan empat makalah mengenai
penerapan keselamatan pasien. Kajian pustaka ini menemukan bahwa perawat telah
melakukan berbagai inovasi untuk memastikan keselamatan pasien di rumah sakit.
Kesimpulan: Keselamatan pasien adalah faktor utama dalam kepuasan pasien
selama berada di rumah sakit, dan inovasi ini dapat menjadi contoh bagi rumah sakit
lain untuk meningkatkan kualitas pelayanannya.
Kata kunci: Perawat; Keselamatan Pasien
1. Introduction
Patient safety is the most important issue in the world (Yanıkkerem et al., 2018),
An estimated 10-25% of hospitalized patients experience patient safety incidents
(Boersma Robertson et al., 2023). Patient safety is an effort to prevent incidents that
adversely affect patients that can cause injury or disability (Storesund et al., 2019), by
using quality practices that produce optimal health services (Littlewood et al., 2019).
Efforts made by the Government of Indonesia to reduce patient safety
incidents are by implementing hospital standardization through, the Hospital
Accreditation Commission (KARS) in 2022 which six Patient Safety Target Indicators
(IPSG) namely correctly identifying patients, improving effective communication,
increasing the safety of high vigilance drugs, ensuring the correct location,
procedures, and surgeries in patients; reduction of the risk of infection associated
with health services and reducing the risk of patient injury due to falls (KEMENKES
RI, 2022)
Preventing safety incidents is the main role of nurses in hospitals because
nurses are the most dominant health workers in Indonesia and have a direct
relationship with patients (Coronado-Vázquez et al., 2017). Nurses are also always
around patients during health services (Zamorano et al., 2023). This position makes
the nurse's role very instrumental in preventing patient safety incidents.
Previous literature reviews have shown that nurse compliance is critical to
patient safety (Hada et al., 2021). To clarify the results of research on the application
of patient safety by nurses in hospitals, it is necessary to provide evidence of the
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development of patient safety applications carried out by nurses. This literature

study aims to explain the results of research on the application of patient safety by
nurses in hospitals, then analyze it to be used as an evidence-based practice for
hospitals to be able to improve the quality of service to patients, safe, quality and
quality.
2. Methods
Literature Search Strategy
Search strategies are developed and implemented using a combination of
keywords using Indonesian are patient safety, compliance, and implementation of
patient safety by nurses. Keywords in English are patient safety for and adherence,
or and implement patient safety by a nurse.
Inclusion criteria include: 1) implementation of patient safety carried out by
nurses, 2) research design is qualitative and quantitative, 3) research using
quantitative or qualitative methods 4) empirical papers in English or Indonesian
published between 2018-2023.
Article selection mechanism
The systematic review was conducted by referring to the PRISMA (Preferred
reporting items for systematic reviews and meta-analysis) guidelines (Madushika &
Lu, 2023). Online databases namely Scopus, Pubmed, Google Scholar, Google, and
Grey literature (National Library of Indonesia,) are systematically searched for
empirical papers in English and Indonesian published after the last paper reviewed
i.e. 2012-2017.
The paper search was carried out by the first and second researchers between
October 20-30, 2023. The first and second studies together searched for online data
and then combined. After that, the narrative synthesis is carried out separately and
then the results are discussed. Search results are identified to issue duplicate papers.
Screening is carried out by reviewing the title and abstract of the remaining papers to
select papers that are relevant to the purpose.
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Figure 1.
PRISMA Diagram
Data Extraction
After the article selection process is complete, the article is synthesized by
containing the following information: researcher, year, title, location, research
objectives, research design, samples, instruments, and results. The results of this
synthesis are presented in Table 1.
3. Result
Article Characteristics
The search yielded 290 articles with details, 12 articles from Scopus, 225
articles from Pubmed, 14 articles from Google, and 39 articles from Google Scholar. A
total of 199 irrelevant papers and two double papers were found through screening
based on title and abstract. A total of 91 complete paper manuscripts were examined
separately according to the inclusion criteria by two researchers. The results showed
that 35 papers conducted drug dosing trials, nine papers were not in English or
Indonesian, three systematic review papers, three papers on the role of doctors in
implementing patient safety, eleven inaccessible papers, five dissertation papers,
seven incomplete papers, and five papers published before 2018. Thirteen papers that
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were declared eligible were thoroughly examined before narrative analysis (Figure
1).
Thirteen papers were synthesized. All papers focus on how nurses keep
patients safe. This implementation is divided into six parts, namely health policy, fall
risk reduction, implementation of effective communication (handover),
implementation of Surgical safety checklist (SSC), infection risk reduction, and
patient safety implementation (Table 1).
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Table 1 Characteristics of the article
No Author Year Title Purpose Design Sample Instrument Result

s
1. Seo Ja-Kyung, 2023 Effects of This study aimed This 1,053 Using the The findings suggest that the
Lee Seung Eun Nurses' to (a) examine the correlationa nursing Climate implementation of effective and
Perceptions relationship l study staff in Safety useful regulations and
of Patient between nursing involves a South Subscale procedures to improve patient
Safety Rules staff's perceptions secondary Korea safety will facilitate error
and of patient safety analysis of communication and peer support,
Procedures regulations and cross- thereby improving the patient
on Their procedures and sectional safety performance of nurses.
Patient Safety their patient survey data Implications for Nursing
Performance: safety Management. Hospital
The performance and administrators and nurse
Mediating (b) investigate managers should consider how
Roles of potential they can create conditions in
Communicati mediators of this which nurses view regulations
on about relationship. and procedures regarding patient
Errors and safety as useful and effective
Coworker
Support
2. Chellan 2018 Perceptions To align with the Descriptive 4 private National Research shows that the overall
Jamila, Sibiya of nursing legislative and exploratory hospitals Core rate of return in quantitative
Maureen staff policy mandates with in the Standards phase research is measured at
Nokuthula regarding the of the quantitative eThekwi (NCS) 86.66%. There is significant
existence of Department of design ni Questionnai agreement from the nursing staff
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best practice Health, the district re at the four hospitals in the group
standards in Health Standards with that best practice standards for
selected Compliance Hospital patient care exist in selected
private Office developed codes A, private hospitals in the eThekwini
hospitals in the National Core B, C, and district, linked to the domains of
eThekwini Standards (NCS) D. The Patient Rights, Patient Care, and
district, for Healthcare total Support Services. The follow-up
South Africa Companies in populati stage of reviewing policy
South Africa that on of documentation, procedures, and
provide service nurses is directives as identified by
quality 569 participants is undertaken to
benchmarks that people of validate the findings of these
can be used to which outcomes. The goal now is
monitor 270 ongoing education and training
healthcare people to ensure best practice standards
delivery. are used are consistently applied for safe
Through the as patient care. This requires
application of research management commitment and
NCS samples responsibility in the form of
education and training, both at
the operational and unit levels.
These levels of hierarchy must
work together to implement and
maintain standards and best
practice processes.
3. Burns Beech, 2022 Turn that To introduce Application doctor, Aplikasi Basic compliance using the
Heilman frown upside visual cues on the of visual nurse, electronic Report Invoked button before the
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James, Kusin down: ED electronic cues and ER, health implementation of our visual
Shana, Chess Implementati medical record call report Oregon record intervention was 9.8%. With staff
Laura, Tanski on of a visual board (EHR) to compliance Health & (EHR) ED education alone, compliance
Mary cue improves communicate that before Science increased to 41.3%. However,
Elizabeth communicati a report has been patient Universit with easily recognizable visual
on during provided will transport y cues highlighted on the
emergency improve through a Hospital trackboard and improved
department handover series of compliance workflows soon
to inpatient compliance multiple- increased to >97% and have been
hand-offs cycle Plan maintained for 84 months. In
Do Study addition, we did not report any
Act (PDSA) incidents of patients being
transferred to hospital beds
before physician reports were
called since implementation. Our
study shows that simple visual
cues and the incorporation of
easy-to-use processes in
workflows can improve
compliance by ensuring reports
are called before patients are
transferred from the ER. This may
have a positive impact on
physician communication and
patient safety during the
admission process
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4. Pajri Wulan 2021 The To determine the Quantitativ 40 questionnai The analysis used was univariate
Oktopia, relationship relationship e with Nurses res and analysis with frequency
Susi Erianti, between between correlation (4 Men, observation distribution tables and bivariate
Rani Lisa motivation motivation and descriptive 36 sheets analysis using the Fisher test. The
Indra and the level the level of nurse research Women) results showed that motivation
of nurse compliance in design. was not related to nurse
compliance carrying out compliance in carrying out
in carrying handovers. handovers in the inpatient room
out with P value = 0.407 (P≤ 0.05)
handovers in
the inpatient
room
5. Penulis: Arrah 2020 Implementati Objective: To Experiment Multiple The Lowa The risk of falling decreased by
L. Bargmann, on Of A develop, s hospitals Model 55% and staff adherence to
Maj Stacey M. Multicompon implement, served as interventions for high fall-risk
Brundrett. ent Fall results, and the patients increased to 89%.
Prevention challenge the framework
Program: implementation for the
Contracting of an enhanced EBP project
With Patients evidence-based
For Fall fall prevention
Safety safety program in
a surgical medical
unit
6. Penulis: 2020 Clinical To determine the Nonrando 3408 SSC WHO Adherence to the postoperative
Anette Efficacy Of relationship mized and SURPASS checklist was
Storesund, Combined between the cluster step- SURPASS associated with decreased
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Mccn, Arvid Surgical combined use of wedge readmission (OR, 0.32; 95% CI,
Steinar Patient Safety preoperative and clinical trial 0.16-0.64; P = 0.001). No changes
Haugen, System And postoperative were observed in mortality or
Hans Flaatten, World Health SURPASS and the LOS. In parallel control units,
Monicaw. Organization WHO surgical complications increased (OR,
Nortvedt, Geir ’s Checklists safety checklist 1.09; 95% CI, 1.01-1.17; P = 0.04),
Egil Eide, In Surgery A (SSC) in while re-operation, readmission,
Marja A. Nonrandomi perioperative care and death remained unchanged.
Boermeester, zed Clinical with morbidity,
Nick Sevdalis, Trial mortality, and
Øystein length of
Tveiten, hospitalization
Ruby
Mahesparan,
Bjørg
Merete
Hjallen,
Monas
Meling
Fevang,
Catrine Hjelle
Størksen,
Heidi Frances
Thornhill,
Gunnar Helge
Sjøen, Solveig
Moss Kolseth,
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Rune
Haaverstad,
Oda
Kristine
Sandli, Eirik
Søfteland
7. Lerson 2020 Factors To analyze factors Analytical 62 SOP bundle There is a relationship between
Hutagaol, related to related to nurse surveys Nurses HAIs tenure and compliance with the
Yayat Suryani, nurse compliance in with (5 Men, ISK bundle, and there is a
Lilis compliance implementing correlationa 57 relationship between leadership
Rohayani, in the SOPs bundle of l design Women) style and compliance with the
Asep implementati HAIs in the implementation of the SOP
Setiawan, on of the SOP inpatient room bundle of HAIs and the IDO
Murtiningsih Bundle bundle. Democratic and
Healthcare- authoritarian leadership styles are
Associated the types of leadership styles
Infections most related to nurse compliance
(Hais) in the in implementing SOP bundle
inpatient HAIs (p 0.018), especially in the
room of implementation of SOP bundle
Bandung IAD (p 0.040).
Adventist
Hospital
8. Indiyani, 2020 Nurse's To determine the Descriptive 82 SOP hand Most room heads performed well
Mona perception of relationship correlation Nurses hygiene with 76 (92.7%) and 78 (95.1%)
Saparwati, the head of between nurses' checklist adherent in their patient safety
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Eko Susilo the room perceptions of the practices: 78 (95.1%) were

direction head of the room disciplined in hand hygiene. The
function direction function results of statistical tests using
regarding with nurses' Fisher's Exact Test obtained a p-
compliance compliance in value of 0.001 (α = 0.05).
in carrying carrying out hand
out hand hygiene in the
hygiene in Inpatient Room
the inpatient of the Hospital
room
9. Hoffmann 2020 Hand To improve hand Single- 12 5 Moments In total, 10,315 "my five moments
Magdalena, hygiene hygiene center intensive Hand for hand hygiene" were observed.
Sendlhofer compliance compliance and observation care Hygiene The average hand hygiene
Gerald, in intensive prevent al study units Observation compliance rate increased from
Gombotz care units: healthcare-related using direct between Sheet 75.1% to 88.6% during the study
Veronika, An infections, the observation 2013 and period, and an estimated increase
Pregartner observational "German Clean and 2017 of about 4.5% per year is
Gudrun, study Hands feedback. expected. However, there were
Zierler Renate, Campaign" differences in compliance
Schwarz intervention was between occupational groups
Christine, Tax implemented in (physicians: between 61.2% and
Christa,Brunn university 77.1%; nurses: between 80.2% and
er Gernot hospitals. 90.9%; others: between 61.3% and
82.4%). Conclusion: After the
implementation of the
intervention "German Clean
Hands Campaign", a significant
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improvement in hand hygiene

was detected. Compliance
measurement helps raise
awareness among healthcare
professional groups.
10. Taufik 2020 Factors To determine the Cross- 102 Questionnai The head nurse's leadership style,
Alhidayah, Related With factors related to sectional Nurses res were rewards, attitudes, and
Susilaningsih, Nurse nurse compliance (41 Men, developed motivation have a significant
& Somantri Compliance in the application 61 by relationship with the level of
In The of patient safety Women) researchers adherence in the application of
Implementati objective regarding patient identification and
on Of Patient indicators attitudes, effective communication. The
Safety motivations reduction in the risk of infection
Indicators At , leadership is influenced only by the
Hospital styles of leadership style of the head of the
room room and the positive attitude of
heads, work the nurse. None of the factors had
design, a significant relationship with
rewards, nurse compliance rates in the
and levels implementation of fall risk
of reduction.
compliance.
11. Suryani, 2021 Factors To examine Cross- 117 Questionnai A significant association indicates
Kurniawan, Associated factors related to sectional Nurses res related knowledge, supervision,
& Perdani With The the to variables motivation, and implementation
Implementati implementation such as of patient safety objectives (p-
on Of of patient safety knowledge, value < 0.05).
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Patient Safety objectives motivation,

At X supervision,
Hospital, length of
Karawang, work, and
Indonesia observation
instruments
, to
implement
six patient
safety goals
12. Yuni Dwi 2020 Factors To analyze the Correlation 220 Using The presence of supervisory
Hastuti, Shofa Influencing factors affecting al Nurses questionnai influence (p = 0.038; OR = 1.828),
Chasani , M. Nurses' nurse compliance descriptive (56 Men, res authority figure character (p =
Hasib Ardani Compliance with patient research 164 developed 0.001; OR = 2.648), and
With safety policies in with a Women) by disobedient coworkers (p =
Patient Safety the inpatient cross- researchers 0.0001; OR = 2,899 ) on nurse
Policies In ward sectional compliance with patient safety
Hospital approach policies. However, gender (p =
0.691), work environment (p =
0.891), and conflicting orders (p =
0.243) were found to not affect
nurses' compliance with patient
safety policies.
13. Eman Aly 2020 Nurses' To determine Descriptive 88 Patient Less than two-thirds of the study
Abd Compliance nurses' Nurses safety subjects did not comply with
Elhamid, To compliance with (27 Men, guidelines nurse-patient safety, whereas
Nehad Ezz Patient And patient and 61 nurses complied with
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Eldin Environment environmental Women) environmental safety with 62.5%

Abdallah, al Safety safety guidelines in critical care units
Safaa Guidelines In in critical care
Mohamed Critical Care units
Abd El Units
Rahman
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The literature review found two papers on health policy. The correlational
study involved a secondary analysis of cross-sectional survey data of 1,053 nursing
staff in South Korea. The findings suggest that the implementation of effective and
useful regulations and procedures to improve patient safety will facilitate error
communication and peer support, thereby improving nurse-patient safety
performance. Implications for Nursing Management. Hospital administrators and
nurse managers should consider how they can create conditions in which nurses
view regulations and procedures regarding patient safety as useful and effective (Seo
& Lee, 2023).
The second paper harmonizes the legislative mandate with an exploratory
Descriptive study with a quantitative design of 4 private hospitals in the eThekwini
district with Hospital codes A, B, C, and D. The total nursing population is 569
people of which 270 people are used as research samples. The results showed that the
overall rate of return in the quantitative phase of research was measured at 86.66%.
There is significant agreement from the nursing staff at the four hospitals in the
group that best practice standards for patient care exist in selected private hospitals
in the eThekwini district, linked to the domains of Patient Rights, Patient Care, and
Support Services. The follow-up stage of reviewing policy documentation,
procedures, and directives as identified by participants is undertaken to validate the
findings of these outcomes. The goal now is ongoing education and training to
ensure best practice standards are consistently applied (Chellan & Sibiya, 2018).
Found two papers on the application of effective communication, namely
handover. The first paper is the application of visual cues and call report compliance
before transporting patients through a series of several cycles of the Plan Do Study
Act (PDSA) to doctors, nurses, ER, and Oregon Health & Science University Hospital
in America. The baseline Compliance Result using the 'Report Called' button before
the implementation of our visual intervention was 9.8%. With staff education alone,
compliance increased to 41.3%. However, with easily recognizable visual cues
highlighted on the trackboard and improved compliance workflows soon increased
to >97% and have been maintained for 84 months. In addition, we did not report any
incidents of patients being transferred to hospital beds before physician reports were
called since implementation. Our study shows that simple visual cues and the
incorporation of easy-to-use processes in workflows can improve compliance (Burns
et al., 2022)
The second paper is a quantitative research with a correlation descriptive
research design to 40 nurses in the inpatient room of RSUD Petaa Bumi, Riau,
Indonesia. The results showed that motivation had no relationship with nurse
compliance in carrying out handover in the inpatient room with P value = 0.407 [P≤
0.05] (Oktopia et al., 2021).
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Papers on fall risk reduction there was only one that intervened in patient and
family education, attaching visual cues and administering non-slip socks, safety coir,
and bed alarms, after which a fall risk assessment was carried out using the Johns
Hopkins Fall Assessment Tool (JHFAT). The results showed that the fall rate
decreased by 55% and staff adherence to interventions for high-fall-risk patients
increased to 89% (Bargmann & Brundrett, 2020).
One paper that researches SSC. The paper conducts the application of SSC and
the comprehensive surgical patient safety system (Surpass) to reduce errors in
surgical risk, the results of the study show that the application of SCC and Surpass
reduces the rate of complications, re-surgery (Storesund et al., 2020).
The paper on reducing the risk of infection found three papers. These three
papers assess the importance of the role of the head of the room in preventing the
risk of infection in hospitals. The first paper researches compliance in implementing
standard operating procedures for preventing infection risk. The results showed that
democratic and authoritarian leadership styles are the types of leadership styles most
related to nurse compliance in implementing SOP bundle HAIs [p 0.018], especially
in implementing SOP bundle IAD [p 0.040] (Hutagaol et al., 2021)
The second research paper links with the head of a room direction function
and nurse compliance in performing hand hygiene. The results showed that there
was a relationship between nurses' perceptions of the head's directing function with
nurses' compliance in practicing hand hygiene (Indiyani et al., 2021).
Third research paper A single-center observational study using direct
observation and feedback to employees of 12 intensive care units between 2013 and
2017. Results In total, 10,315 "my five moments for hand hygiene" were observed. The
average hand hygiene compliance rate increased from 75.1% to 88.6% during the
study period, and an estimated increase of about 4.5% per year is expected. However,
there were differences in compliance between occupational groups (physicians:
between 61.2% and 77.1%; nurses: between 80.2% and 90.9%; others: between 61.3%
and 82.4%). Conclusion: After the implementation of the intervention "German Clean
Hands Campaign", a significant improvement in hand hygiene was detected.
Compliance measurement helps raise awareness among healthcare professional
groups.
Four papers discussing the application of patient safety. The first paper
conducted a study in one of the Cilacap regional hospitals, Central Java, Indonesia
which aimed to find the relationship between nurse compliance in the
implementation of patient safety goals namely correct patient identification, effective
communication, nosocomial infection risk reduction and fall risk prevention, the
results showed that the leadership style of the head of the room, appreciation,
attitude and motivation had a meaningful relationship to nurse compliance and
Implement correct patient identification and effective communication. Nosocomial
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infection risk reduction had a significant relationship with nurses' leadership style
and positive attitudes, while fall risk prevention was not associated with gender,
education level, attitudes, motivation, leadership style, work environment, and
rewards. The head of the room's consultative leadership style can change the level of
obedience (Alhidayah et al., 2020).
Another paper also conducted a study in hospitals, which gave results that
knowledge, supervision, motivation, and implementation of patient safety objectives
[p-value < 0.05] (Suryani et al., 2021).
Other papers were also found to show that the influence of supervision, the
character of authority figures, and non-compliant co-workers influenced nurses'
decisions to carry out patient safety. However, gender (p=0.691), work environment
(p=0.891), and conflicting orders (p=0.243) were found to not affect nurses'
compliance with patient safety policies (Hastuti et al., 2020).
Another paper also conducted a study by comparing several rooms in
hospitals to find out which rooms are compliant with patient safety practices. The
results showed that less than two-thirds of nurses were not compliant with patient
safety. Intensive care unit has the highest compliance score compared to the medical
intensive care unit, chest intensive care unit, obstetrics intensive care unit,
neurosurgery intensive care unit, pediatric intensive care unit, cardiothoracic
intensive care unit and coronary care unit (Elhamid et al., 2020).
4. Discussion
The role of the nurse is urgent in the application of safety. Implementing patient
safety is an important task for nurses because nurses are the largest group of health
professionals who are most interactive with patients (Yıldız & Karagözoğlu, 2023).
Nurses have also been shown to be able to create simple and effective strategies to
prevent and reduce the risk of patient safety incidents (Matsumoto et al., 2021). Other
studies have also suggested that nurses can also function to recognize and respond to
deteriorating patient safety (Bernstein et al., 2022).
To spur nurses to improve patient safety, nurses need to create a broader vision
of patient safety systems and processes to ensure the safety and quality of care they
provide (Tunçer Ünver & Harmanci Seren, 2018). In addition, according to other
opinions, nurses also need to improve their knowledge, skills, and motivation for
patient safety to improve health services (Wilson et al., 2022). Other research has also
argued that the more knowledgeable nurses are and the more positive attitudes they
have, the better they will be at implementing patient safety (I. A. S. S. Nurjaman, 2023).
Many factors influence nurses to implement patient safety: patient participation,
knowledge and attitudes of health care providers, nurse collaboration, appropriate
equipment and electronic systems, education and feedback, and standardization of
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care processes (Ricou Ríos et al., 2023). In addition, there is also the influence of age,
education level, work experience, knowledge, attitudes, work culture, and motivation
on the application of patient safety by nurses (Vázquez-Calatayud et al., 2021).
The role of the head of the room also affects the implementation of patient
safety, such as research conducted at several magic houses in Parana, which concluded
that although the strategy of implementing patient safety is contradictory, it has a
feeling of satisfaction (I. Nurjaman & Saparlina, 2023b, 2023a) In addition, work design
is also very influential on the implementation of patient safety if the perception of
nurses' work is good, the implementation of patient safety will also be good (Lee et al.,
2022)
Surgery is an action performed to diagnose and treat diseases and body
deformities by making wounds that can cause physiological changes in the body and
can affect other bodies (Bąk-Sosnowska et al., 2022). Patient safety incidents in the
operating room are related to human factors (Serou et al., 2022), communication
breakdown (Krishnan et al., 2022), and Environmental disturbances (Katz, 2017).
To prevent such incidents, it is recommended to use SSCs which are patient
safety instruments in the operating room that aim to improve communication and
teamwork as well as evidence-based compliance (Anwar et al., 2023). The use of SSCs
has been shown in other studies that nurses have more knowledge about SSCs than
other medical personnel in the operating room (Altaweli et al., 2023).
There are three times when patient safety incidents occur in the operating room:
before anesthesia, before the incision, and before the patient leaves the operating room
(Anwar et al., 2023). The use of SSCs has also been shown to reduce incidents during
emergency operations (Wojciechowicz et al., 2010).
There are many factors for nurses not using SSC in the operating room such as
no policy regarding the implementation of SSC, lack of socialization about SSC, lack of
knowledge about SSC, lack of awareness of the importance of using SSC and filling
SSC an additional workload (Altaweli et al., 2023). Other studies also say SSCs are not
used because they make workloads heavier and lack capabilities for SSC
implementation (Anwar et al., 2023). The use of SSCs does not increase the workload
and has the effect of reducing the overall cost of each surgical procedure
(Wojciechowicz et al., 2010). Increasing the use of SSCs in operating rooms requires
optimal leadership, clear delegation of responsibilities from health workers,
collaboration between team members, and institutional support in providing the
necessary human and material resources (Altaweli et al., 2023).
Healthcare-Associated Infections (HAIs) commonly called nosocomial
infections are infectious events that occur in patients during the treatment process at
healthcare facilities (Anwar et al., 2023). Health facilities if patients are infected can be
a source of infection transmission to other patients, health workers, and visitors
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(Anwar et al., 2023). This infection occurs more than 48 to 72 hours after admission
and within ten days after discharge from the hospital.
HAIs have dangerous side effects that can exacerbate bodily dysfunction and
cause emotional stress, as well as increase morbidity (Fresán-Ruiz et al., 2022). HAIs
can also extend the length of patient care, increase hospital costs, cause a decrease in
quality of life, and even lead to death. HAIs can also cause illnesses ranging from mild
skin infections to life-threatening conditions such as sepsis (Shibabaw et al., 2023).
Hand hygiene is the most important intervention to prevent HAIs, but many
health workers still do not adhere to recommended hand hygiene procedures (Anwar
et al., 2023). Although other studies say that the majority of hand hygiene has been
applied, the implementation of washing hands first before wearing gloves and the use
of personal protective equipment is still low (Alam et al., 2022). This is different from
other studies, although the level of knowledge is sufficient, infection control practices
are well underway (Briquet et al., 2023).
Nurses' lack of knowledge about infection control principles has a significant
association with increased HAIs (Anwar et al., 2023). Lack of training is also an
obstacle to controlling the incidence of infection in hospitals (Fresán-Ruiz et al., 2022;
Shibabaw et al., 2023). Although providers have provided knowledge-building tools in
the form of infection control and prevention training, only 32% percent attend
(Gareeballah et al., 2023). It is very important to carry out continuous preventive
efforts to prevent the occurrence of HAIs (Fresán-Ruiz et al., 2022).
Communication problems are one of the causes of patient safety incidents that
are not related to the patient's illness or condition (Jin & Gil, 2023). Effective
communication processes are critical to building trust and openness which are
important characteristics of a patient safety culture. Ineffective communication occurs
because communication between nurses and patients is a complex interaction that
requires a two-way response (Dodson et al., 2023).
To avoid this, WHO recommends using effective communication using the Joint
Commission International's Situation, Background, Assessment, and Recommendation
(SBAR). SBAR was initially implemented in healthcare settings with the intent to
improve nurse and physician communication in acute care situations, but it has also
been shown to increase communication satisfaction among healthcare providers as
well as their perception that communication is more appropriate (Yun et al., 2023).
SBAR provides evidence that there is an improvement in the quality of communication
between health professionals that ensures increased safety of patient care (Martínez-
Fernández et al., 2022).
Communication barriers also occur during the weigh-in process. Weigh-in is the
process of passing patient-specific information from one care group to another aimed
at ensuring continuity and safety of patient care according to the Joint Commission
International. Communication barriers occur due to hierarchical reporting structures,
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gender, education, cultural background, stress, burnout, ethnic differences, and social
structures (Martínez-Fernández et al., 2022). In addition, information gaps and
omissions in weigh-in reports can also result in patient safety incidents (Jin & Gil,
2023).
The consequences of communication barriers during weigh-in are medication
errors, inaccurate patient plans, delays in transferring patients to critical care, delays in
discharge from the hospital, and repetition of medical tests (Jin & Gil, 2023). At the
time of weighing the information submitted must be clear, complete, accurate, and
understood by the recipient. In addition, it has been suggested that the weigh-in
process should have clear standards and health workers should be trained on the most
effective, safe, satisfactory, and efficient way to weigh and receive them.
Falls are one of the most frequent incidents in hospitalization and can lead to
increased health care costs, increased length of stay, and increased risk of disability.
Some studies agree that to prevent fall incidents it is necessary to identify risk factors
(Jin & Gil, 2023; Martínez-Fernández et al., 2022). Some studies also emphasize that it
is very important to assess each patient's risk factors. This is done to obtain
information for the prevention of falling incidents while the patient is in the hospital
(Badawy et al., 2023).
One fall risk assessment is using the Morse scale (Kovalenko & Kanorskii, 2022).
This assessment needs the active role of the nurse during the patient's stay in the
hospital. Nurses can use scales for patient identification, falling risk can allow nurses
to have control to prevent patients from falling. So nurses need to identify the most
vulnerable things in patients while in the hospital that can cause fall incidents (Álvarez
et al., 2023).
Nurses are also proven to have a key role in efforts to keep patients from falling
incidents during their stay in the hospital (Ladios-Martin et al., 2022). The nurse can
also serve as a strategist or intervention to prevent fall incidents. Other studies have
also argued that the knowledge and experience of nurses are also very important in
preventing the risk of falls in patients (Chrdle et al., 2023).
Reduction of fall risk incidences requires creating patient-focused programs and
interventions, as evidenced by 19 articles reviewed by (Miake-Lye et al., 2013), proving
that the success rate is 30%. Some nurse actions that are often negligent in preventing
fall risk are not conducting a fall risk assessment every day, not providing adequate
transportation for the baby, not verifying medications that can alter mobility and
balance, not placing children with a history of fall risk close to the nurse's station and
forgetting to record incident evaluations and reports (Thomson et al., 2017).
5. Conclusion
This study shows that the implementation of patient safety is carried out by
nurses to prevent patient safety incidents in hospitals. Nurses as dominant health
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workers and always in direct contact with patients make it have an important role in
carrying out patient safety. There needs to be increased knowledge through training,
as well as monitoring and evaluation to instill a culture of safety.
Acknowledgments
The author acknowledges the assistance offered by the head of the master of
nursing study program at Jenderal Ahmad Yani University, Cimahi. Mrs. Dr. Iin
Inayah, M.Kep in selecting potential articles. In systematic literature review research.
Financial support and sponsorship

Nil.
Conflicts of interest
There are no conflicts of interest.
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MEDIC NUTRICIA 2023, Vol. 1, No.

SYSTEMATIC LITERATURE REVIEW: NURSES AND PATIENT SAFETY

Iman Nurjaman1*, Ina Saparlina2

development of patient safety applications carried out by nurses. This literature

Table 1 Characteristics of the article

No Author Year Title Purpose Design Sample Instrument Result

Eko Susilo the room perceptions of the practices: 78 (95.1%) were

improvement in hand hygiene

Patient Safety objectives motivation,

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