Table 3.

Study aims and main results

No	Ref. No	Study aim	Main result
1	[11]	To identify associations between PSC and health care quality in NH	• None of the NHSPSC measures were significantly associated with the staffing five-star rating.
2	[12]	To determine the associations of PSC with the Nursing Home Compare enforcement outcomes and 5-star ratings on multiple domains of care	Every increase of 10% points in the overall positive response rate for safety culture was associated with • 0.56 fewer healthcare deficiencies (p = .001), • 0.74 fewer substantiated complaints (p = .004), • Reduced fines by $2285.20 (p = .059), • Increased odds of being designated as 4- or 5-star (vs. 1–3 star) facilities (odds ratio roughly 1.20, p < .05)
3	[13]	To examine the association between NH safety culture and catheter-associated urinary tract infection rates	• None of the 13 safety culture measures were statistically significant.
4	[15]	To investigate the relationship between employee turnover and PSC in NH	• In NHs with low turnover, the overall PSC scores were 4.04% (RNs) and 6.28% (CNAs), which were higher than scores in NHs with high turnover. • Low turnover of RNs and CNAs exhibited a strong, statistically significant, and positive association with PSC • PSC domains of teamwork, staffing, and training/skills appeared to be particularly related to CNA turnover, but not to RN • PSC domains focusing on collaboration across disciplines and roles—such as compliance with procedures, handoffs, communication openness, and organizational learning—appeared to be equally associated with CNA and RN turnover
5	[16]	(i) To investigate safety attitudes among healthcare providers in NHs, using the SAQ-AV (ii) To investigate whether safety attitudes were related to professional background, age, work experience, and mother tongue	• Increasing age and job position were associated with significantly increased mean scores for patient safety factors (teamwork climate, safety climate, job satisfaction, and working conditions) • Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition • Neither professional background nor work experience was significantly associated with any patient safety factor.
6	[21]	To examine whether CNAs’ perceptions of PSC were correlated with clinical outcomes (rates of falls, pressure ulcers, and daily restraint use)	• High CNA PSC scores positive association with falls (B = 0.015; p = .000) • High CNA PSC scores positive association with moderate restraint use (B = 0.172; p = .017) • CNA PSC scores showed no association with pressure ulcer rates.
7	[22]	(i) To determine safety culture scores for NHs (ii) To compare these results with existing data from hospitals	• 11 of the 12 HSOPSC subscale scores from the NH sample were considerably lower than the benchmark hospital scores. •Almost all item scores from NHs were considerably lower than the benchmark hospital scores.
8	[25]	To analyze how nurses’ PSC perceptions corresponded to their personal and professional characteristics	• US-born and educated nurses demonstrated the lowest perceptions of workplace PSC overall (P < .001)
9	[26]	To perform a transcultural adaptation in French of the NHSPSC questionnaire	•The NHSPSC questionnaire is the first questionnaire on PSC that has been applied to the medico-social sector in France. • The exploratory analysis led to the identification of seven domains; teamwork, staffing, compliance with procedures, handoffs, feedback and communication about incidents, supervisor expectations and actions promoting resident safety, overall perceptions of resident safety and organizational learning.
10	[27]	To examine the overall responses of NH staff to a newly developed NHSPSC and to examine whether NH staff differ in their PSC ratings	• Staff in NHs generally agree that PSC is poor. • Administrators/managers had more positive scores than did other staff types (p < .05) across most domains.
11	[28]	To compare the PSC between nationally representative samples of hospitals and NHs	• Of the 26 highly similar items in these questionnaires, 9 of the NHSPSC scores were lower than the corresponding HSOPSC scores (indicating poorer perceptions of safety culture), 1 score was identical, and 16 were higher (indicating better perceptions of safety culture). • Some learning opportunity may present itself for both nursing homes and hospitals to improve the safety culture.
12	[29]	(i) To examine associations between PSC domains and place of death among residents with dementia (ii) To evaluate the extent to which state minimum NH nurse staffing requirements moderate these effects	• Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death
13	[30]	To assess the association of transformational leadership, job demands, and job resources with PSC and employees’ overall perception of patient safety in NH	• Transformational leadership explained 47.2% of the variance in PSC and 25.4% of the overall perception of patient safety, controlling for age and gender (p < .001). • Job demands and job resources explained 7.8% of PSC and 4.7% of the overall perception of patient safety (p < .001).
14	[31]	To assess not only staff perceptions of PSC in-home care services and NH, but also how various PSC dimensions contribute to explaining overall perceptions of patient safety	• The number of patient safety dimensions with an average of more than 60% of positive responses was 7 out of 10 in NHs, and 9 out of 10 in-home care. • In-home care, the total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs being significant predictors. • The explained variance in NHs was 42.7%, with staffing and communication openness being significant predictors
15	[32]	To investigate PSC and its relationship with obstacles to adverse event reporting in Chinese NHs	• PSC in NHs was associated with facility ownership (p < .001), facility scale (p < .001), reporting management (p < .001), being an integrated care institution or not (p = .006), frequency of concern about patient safety (p = .001), occurrence of adverse events in departments (p = .001) and a punitive atmosphere (p = .044). Obstacles to adverse event reporting were negatively correlated with PSC (p < .05).
16	[33]	To identify organizational climate predictors of specific aspects related to the staff-rated resident safety culture in NHs	• The organizational climate factors “efficiency” and “work climate” predicted non-punitive response to mistakes (p < .001 for both scales) and compliance with procedures (p < .05 and p < .001, respectively). • Work stress was an inverse predictor of compliance with procedures (p < .05). • Goal clarity was the only significant predictor of communication about incidents (p < .05).
17	[34]	(i) To compare the resident safety culture of NH from a nurse aide’s perspective with existing data from hospitals (ii) To examine the differences in the safety culture of NHs according to facility and market characteristics	• All of the 12 HSOPSC subscale scores from the NH sample were considerably lower than the benchmark hospital scores, indicating a less well-developed safety culture. • The resident safety culture of nurse aides in many NHs may be poorly developed.
18	[35]	To describe perceptions of workplace safety culture among nurses employed in long-term care settings	• Nurse managers reported significantly more positive safety culture perceptions than did other licensed staff nurses. • Licensed nurses employed in government-run facilities had significantly fewer positive safety culture perceptions than did those working in nonprofit organizations.
19	[36]	(i) To compare the resident safety culture of NHs from a top management perspective with existing data from hospitals. (ii) To examine how the safety culture of NHs varies according to facility and market characteristics	• 9 of the 10 HSOPSC subscale scores from the NH sample were considerably lower than the hospital scores • The resident safety culture reported by administrators was generally low. • High RN staffing is significantly associated with high resident safety scores.
20	[37]	To assess PSC in the NH setting, in order to determine whether NH professionals differ in their PSC ratings, and to compare PSC scores of NHs with those of hospitals	• NHs scored significantly lower than hospitals (p = .05) in 5 PSC dimensions (non-punitive response to error, teamwork within units, communication openness, feedback and communication about error, and organizational learning)
21	[38]	To assesses staff attitudes regarding safety culture at one 250-bed SNF	• SAQ is a validated and reliable instrument in the SNF setting • No statistically significant differences were found between nursing and other healthcare staff in ratings of the 6 safety constructs or the quality of collaboration and communication between staff members. • RNs, licensed practical nurses, and nurse management/supervisors received the highest ratings for quality of collaboration and communication (very high), whereas nurse practitioners and physician assistants received the lowest (range: 2.5–2.9).
22	[39]	To investigate whether the Norwegian translation of the SAQ-AV is useful to identify significant variations in the patient safety climate factor scores	• It can be used to identify wards in NHs with high and low risk of adverse events • Staff perceptions of safety climate, working conditions, and perceptions of management varied significantly across wards.
23	[40]	To validate the study using the Norwegian translation of the questionnaire in the primary care setting and present the psychometric properties of this version	• The Norwegian-translated version of the SAQ–AV, with the five confirmed factors, might be a useful tool for measuring several aspects of PSC in primary care settings.
24	[41]	(i) To investigate whether the SAQ is appropriate to measure the safety attitude of caregivers in nursing and residential homes (ii) To compare the safety attitude of these caregivers with available data of caregivers in other settings (i.e., inpatients, intensive care units, and ambulatory care)	• SAQ versions were completely applicable in nursing and residential homes • There were positive correlations between teamwork climate, job satisfaction, perceptions of management, safety climate, and working conditions (r = .31 to 63) • Stress recognition had a negative correlation with each of the other dimensions (r = -.13 to -0.18)
25	[42]	To understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care facility	• The respondents perceived the overall state of safety culture to be weak (80% positive response).

CNA Certified nursing assistant, NH Nursing home, RN Registered nurse, NHSPSC Nursing Home Survey on Patient Safety Culture, HSOPSC Hospital Survey on Patient Safety Culture, SAQ Safety Attitudes Questionnaire, SAQ-SNF SAQ in a Skilled Nursing Facility (SNF), SAQ-AV Ambulatory Version of the Safety Attitudes Questionnaire, PSC Patient safety culture