Patient Safety Attitudes Among Intensive Care Unit Nurses in an Indonesian Islamic Hospital: A Mixed-Methods Study
Abstract
Patient safety culture plays a crucial role in intensive care units (ICUs), where nurses play a central role in ensuring safe and quality care. Evaluation of patient safety attitudes in nurses is important to reduce medical errors and improve service quality. This study aims to evaluate patient safety attitudes in nurses in the ICU of an Islamic hospital and propose a strategy for improvement based on the Theory of Planned Behavior (TPB). Mixed-methods with a sequential explanatory model approach, using the Safety Attitudes Questionnaire (SAQ-INA). Quantitative data from ICU nurses were complemented by qualitative interviews, analyzed using the TPB framework. The number of respondents in this study was 14 respondents from both quantitative and qualitative research. ICU nurses showed a positive attitude with high scores on the teamwork climate (82.7%), safety climate (76.3%), and job satisfaction (90.4%). However, low scores on stress recognition (61.6%), unit management perception (66.8%), hospital management (68.6%), and working conditions (74.1%) indicate challenges such as high workload, staff shortages, and lack of management support. The qualitative findings emphasize the need for non-punitive reporting and collaboration between professions. ICU nurses are strongly committed to patient safety, but stress and resource limitations hinder them. Recommendations include stress management training, non-punitive reporting systems, management engagement, and resource optimization to strengthen patient safety attitudes
Keywords: Patient Safety Attitudes, ICU Nurses, Safety Attitudes Questionnaire, Theory of Planned Behavior
Full Text:
PDFReferences
Abuosi, A. A., Poku, C. A., Attafuah, P. Y. A., Anaba, E. A., Abor, P. A., Setordji, A., & Nketiah-Amponsah, E. (2022). Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety. Plos One, 17(10), e0275606.
Ahmed, F. A., Asif, F., Munir, T., Halim, M. S., Ali, Z. F., Belgaumi, A., Zafar, H., & Latif, A. (2023). Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMJ Open Quality, 12(1).
Aldawood, F., Kazzaz, Y., AlShehri, A., Alali, H., & Al-Surimi, K. (2020). Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool. BMJ Open Quality, 9(1).
Alsabri, M., Boudi, Z., Lauque, D., Dias, R. D., Whelan, J. S., Östlundh, L., Alinier, G., Onyeji, C., Michel, P., & Liu, S. W. (2022). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review. Journal of Patient Safety, 18(1), e351–e361.
Alsaqqa, H. H. (2023). Healthcare organizations management: Analyzing characteristics, features and factors, to identify gaps “scoping review.” Health Services Insights, 16, 11786329231168130.
Aung, S. T., & Preudhikulpradab, S. (2021). The middle managers’ essential leadership styles: A case of global technology company in Myanmar. AU-GSB E-Journal, 14(1).
Byrne, K. A., Peters, C., Willis, H. C., Phan, D., Cornwall, A., & Worthy, D. A. (2020). Acute stress enhances tolerance of uncertainty during decision-making. Cognition, 205, 104448.
Chen, Y., & Gong, Y. (2022). Teamwork and patient safety in intensive care units: challenges and opportunities. Studies in Health Technology and Informatics, 290, 469.
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1), 41.
Ein-Gal, Y., Sela, R., Arad, D., Kravitz, M. S., Hanhart, S., Goldschmidt, N., Kedmi-Shahar, E., & Bitan, Y. (2023). Translation and Comprehensive Validation of the Hebrew Survey on Patient Safety Culture (HSOPS 2.0). Journal of Patient Safety, 10–1097.
Fukami, T., Uemura, M., & Nagao, Y. (2020). Significance of incident reports by medical doctors for organizational transparency and driving forces for patient safety. Patient Safety in Surgery, 14(1), 13.
Gleeson, L. L., McNamara, J., Donworth, E., Crowley, E. K., Delaney, A., Sahm, L., O’Mahony, D., Russell, N. E., & Byrne, S. (2023). Healthcare provider perceptions of safety culture: A multi-site study using the safety attitudes questionnaire. Exploratory Research in Clinical and Social Pharmacy, 9, 100228.
Gómez-Salgado, J., Andrés-Villas, M., Domínguez-Salas, S., Díaz-Milanés, D., & Ruiz-Frutos, C. (2020). Related health factors of psychological distress during the COVID-19 pandemic in Spain. International Journal of Environmental Research and Public Health, 17(11), 3947.
Hanafi, A. Z. P. D. (2020). Analisis Implementasi Sasaran Keselamatan Pasien Di Rumah Sakit Umum Daerah Kota Makassar Tahun 2020 [Doctoral dissertation]. Universitas Hasanuddin.
Hashem, Z., & Zeinoun, P. (2020). Self-compassion explains less burnout among healthcare professionals. Mindfulness, 11(11), 2542–2551.
Hong, K. J. (2025). Patient safety management activities and perceived workload of shift‐work nurses, moderated by the perceived importance of patient safety management. International Nursing Review, 72(3), e13069.
Huang, H., Xiao, L., Chen, Z., Cao, S., Zheng, S., Zhao, Q., & Xiao, M. (2022). A national study of patient safety culture and patient safety goal in Chinese hospitals. Journal of Patient Safety, 18(8), e1167–e1173.
Jun, J., Ojemeni, M. M., Kalamani, R., Tong, J., & Crecelius, M. L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies, 119, 103933.
Kemenkes. (2017). Peraturan Menteri Kesehatan Republik Indonesia Nomor 11 Tahun 2017 Tentang Keselamatan Pasien. Occupational Medicine. Indonesia.
Labrague, L. J., Al Sabei, S., Al Rawajfah, O., AbuAlRub, R., & Burney, I. (2022). Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses. Journal of Nursing Management, 30(1), 268–278.
Lee, J., Resick, C. J., Allen, J. A., Davis, A. L., & Taylor, J. A. (2024). Interplay between safety climate and emotional exhaustion: effects on first responders’ safety behavior and wellbeing over time. Journal of Business and Psychology, 39(1), 209–231.
Mandriani, E., Hardisman, H., & Yetti, H. (2019). Analisis Dimensi Budaya Keselamatan Pasien Oleh Petugas Kesehatan di RSUD dr Rasidin Padang Tahun 2018. Jurnal Kesehatan Andalas, 8(1), 131–137.
Murray, J. S., Clifford, J., Larson, S., Lee, J. K., & Sculli, G. L. (2023). Implementing just culture to improve patient safety. Military Medicine, 188(7–8), 1596–1599.
Ningrum, E., Evans, S., & Soh, S.-E. (2019). Validation of the Indonesian version of the Safety Attitudes Questionnaire: A Rasch analysis. PloS One, 14(4), e0215128.
Noble, H. E., Scott, J. W., Nyinawankusi, J. D., Uwitonze, J. M., Kabagema, I., Maine, R. G., Riviello, R., Dushime, T., Enumah, S., & Hu, Y. (2020). The impact of data feedback on continuous quality improvement projects in rwanda: a mixed methods analysis. African Journal of Emergency Medicine, 10, S78–S84.
Olesen, A. E., Juhl, M. H., Deilkås, E. T., & Kristensen, S. (2024). application of the Safety Attitudes Questionnaire (SAQ) in primary care-a systematic synthesis on validity, descriptive and comparative results, and variance across organisational units. BMC Primary Care, 25(1), 37.
Permanasari, I., & Oktamianti, P. (2022). Level of Interprofessional Collaboration in Hospital Intensive Care Unit (ICU). Syntax Literate; Jurnal Ilmiah Indonesia, 7(9), 15037–15051.
Pfeifer, L., Vessey, J., Cazzell, M., Ponte, P. R., & Geyer, D. (2023). Relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing. Journal of Pediatric Nursing, 73, 130–136.
Raykova, E., & Semerdjieva, M. (2019). Methods for managing organizational conflicts in hospital. Knowledge International Journal, 34, 99–105. https://doi.org/10.35120/kij34010099r
Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61, 101860.
Sarhadi, A., Farahani, A. S., Rassouli, M., Nasiri, M., Babaie, M., & Khademi, F. (2023). Determining the psychometric properties of safety attitudes questionnaire in NICUs. BMC Psychology, 11(1), 211.
Schneider, K., Williams, M., Mohr, N. M., & Ahmed, A. (2024). Rural emergency medical services clinicians’ perceptions and preferences in receiving clinical feedback from hospitals: a qualitative needs assessment. Prehospital Emergency Care, 28(5), 735–744.
Thethwayo, M. S., Camp, P., Van Staden, D., Chetty, V., & Maddocks, S. (2024). Exploring interprofessional collaboration in the intensive care unit. South African Journal of Physiotherapy, 80(1), 2098.
Yayehrad, T., Getachew, Y., & Muluken, W. (2024). Patient safety culture and associated factors of regional public hospitals in Addis Ababa. BMC Health Services Research, 24(1), 811.
Yesilyaprak, T., & Demir Korkmaz, F. (2023). The relationship between surgical intensive care unit nurses’ patient safety culture and adverse events. Nursing in Critical Care, 28(1), 63–71.
Zhang, Y., Guan, C., Jiang, J., Zhu, C., & Hu, X. (2023). Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses. Journal of Clinical Nursing, 32(13–14), 3887–3897.
DOI: http://dx.doi.org/10.30829/contagion.v8i1.27183
Refbacks
- There are currently no refbacks.
Copyright (c) 2026 Tri Sutopo, Arlina Dewi

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.




