A comparison of safety climate between nurses working in different clinical settings.

Student thesis: Doctoral ThesisDoctor of Philosophy


Objectives: The aim of this study was to explore the underlying factors that may influence dimensions of safety climate in nursing practice. A mixed methods study was used to explore safety climate in nurses working in operating theatres, critical care units and ward areas. A cross-sectional survey was undertaken using the Safety Climate Questionnaire (SCQ) to undertake a Confirmatory Factor Analysis (CFA) and to compare safety climate. Focus group discussions and thematic analysis were undertaken to explore the meaning of safety climate in nursing practice. Results: The nine factor structure of the SCQ was used as the a priori model for the basis of a CFA of the SCQ. The results indicated that there was a good model fit on some criteria (χ2 = 1683.699, df 824, p < 0.01; χ2/ df = 2.04; RMSEA = 0.058) but a less acceptable fit on Comparative Fit Index (CFI) = 0.804. There was a statistically significant difference in the safety climate dimension of Management Commitment (F [4,266] = 4.66, p = 0.001) where the operating theatre group reported lower safety climate compared with ward areas and the operating theatre focus group also reported negative perceptions about management. Although there was significant variation in safety climate scores for the dimension of Communication across clinical specialism (F [4,266] = 2.62, p = 0.035) none of the pair-wise comparisons achieved statistical significance. The three themes identified in the thematic analysis were Human Factors, Clinical Management and Protecting Patients. The system and the human side of caring was identified as a meta-theme. There were areas of overlap and some differences between the dimensions of the SCQ and the findings of the thematic analysis. Conclusions: The results suggest that the SCQ has some utility but requires further exploration for use in nursing practice. There were differences between different clinical areas for Management Commitment and Communication. The measurement of safety climate is complex and the findings of the thematic analysis indicate that safety in nursing practice has a complex relationship between safety systems and the social and interpersonal aspects of clinical practice.
Date of Award2016
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorTrevor Murrells (Supervisor) & Anne Jones (Supervisor)

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