KAAF UNIVERSITY COLLEGE

FACULTY OF HEALTH AND ALLIED SCIENCE

KNOWLEDGE OF NURSES AND MIDWIFES TOWARDS IN-PATIENT SAFETY AT

THE ST. GREGORY CATHOLIC HOSPITAL GOMOA EAST DISTRICT

BY

LISTOWEL DIKA

(PG42100323)

THIS THESIS WAS SUBMITTED TO THE FACULTY OF HEALTH AND ALLIED

SCIENCE OF KAAFUNIVERSITY COLLEGE, IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE AWARD OF A MASTERS OF PHILOSOPHY

2024
 ABSTRACT

Patient safety is a top priority area to prevent and minimize risks, mistakes, and harm to patients
throughout the delivery of medical treatment. The fact that a growing number of people die in hospitals
each year as a result of shortcomings in patient safety procedures, however, makes patient safety one of
the most difficult issues in healthcare.

This study seek toexplored the knowledge of nurses and midwifes towards in-patient safety at the St.
Gregory Catholic Hospital.

This study seek to employed a cross-sectional quantitative design to collect data among 100 nurses and
Midwifes. Random sampling would be used to select the participants and the data would be collected
using a structured questionnaire. Data collected would cleaned using excel and exported into stata 17 for
analysis. Percentage and frequencies would be obtained for variables and mean and standard deviation
would be used for continuous variables.
 CHAPTER ONE

INTRODUCTION

Background information

Patient safety is a top priority area to prevent and minimize risks, mistakes, and harm to patients
throughout the delivery of medical treatment (Vaismoradi et al., 2020). Patient safety, which emphasizes
the avoidance and mitigation of damage to patients during their interactions with the healthcare system, is
a vital component of high-quality healthcare. The fact that a growing number of people die in hospitals
each year as a result of shortcomings in patient safety procedures, however, makes patient safety one of
the most difficult issues in healthcare (Wake et al., 2021).

According to the World Health Organization Safety Report, globally during primary and outpatient
medical treatment, up to 4 out of 10 patients experience damage. Avertable injury can be up to 80% of the
time. Errors in diagnosis, prescription, and medication usage are the most harmful (WHO, 2019).
According to Dhingra-Kumar et al. (2021), 2.6 million people die each year as a result of an estimated
134 million adverse events brought on by subpar medical treatment in hospitals in low- and middle-
income nations.

Through their expertise, abilities, and adherence to best practices, nurses and Midwifes, who serve as
front-line caregivers, are crucial in maintaining patient safety (Vaismoradi et al., 2020). For nurses and
Midwifes to effectively prevent medical mistakes, and adverse events, and improve patient outcomes,
they must possess a sufficient understanding of patient safety. For the majority of healthcare workers,
nurses and Midwifes are crucial to maintaining patient safety. They are the largest group of these
professions. Nurses and Midwifes are in charge of giving patients direct care on an ongoing basis,
keeping track of their health, giving them medicine, avoiding infections, and reporting any mistakes or
negative outcomes (D’Amour et al., 2014). To improve the quality and safety of care, nurses and
Midwifes must have the necessary knowledge, attitude, and practices.

Studies conducted in the past, however, have revealed that nurses' and Midwifes’ understanding, attitudes,
and practices regarding patient safety are subpar and vary among settings and nations. For instance,
research done in Ethiopia indicated that just 48.4% of nurses and midwifes had adequate expertise and
that 56.1% of them had a positive attitude toward patient safety (Netsere et al., 2020). Another study
conducted in Vietnam found that only 65.9% of nurses and midwifes had good knowledge of patient
safety (Phuong & Do, 2022). Moreover, a systematic review found that patients' involvement, healthcare
providers' knowledge and attitudes, nurse and midwife collaboration, standardization of the care process
are just a few of the variables that have an impact on nurses' and midwifes’ adherence to patient safety
principles (Vaismoradi et al., 2020).

Nurses' and Midwifes’ awareness of patient safety is influenced by a variety of circumstances, including
workload, time constraints, and support from superiors and peers. Nurses and Midwifes who work in
wards that perform well and offer education for the betterment of their expertise and abilities tend to have
more knowledge and adherence to patient safety than caregivers who do not, and nurses and midwifes
who work in wards that face high workloads, time constraints, and a lack of encouragement from
supervisors and co-workers tend to have less understanding and compliance with patient safety than those
who do (Kieft et al., 2014; Vaismoradi et al., 2020). However, factors like fewer obvious mistakes, the
capacity to convey recommendations, information technology assistance and training, and the chance that
nurses midwifes use their facility increase patient safety and the likelihood that nurses and midwifes
utilize it, and a private system for reporting errors (Zimmerman et al., 2013). The importance of a nurse's
and midwife’s contribution to patient safety can be affected by a variety of elements, including their
workplace and the degree of leadership support they get. Nursing and Midwifery leaders may establish a
culture of patient safety by controlling these elements and do so while also enhancing clinical results (Liu
et al., 2018).

A nurse's and midwife’s understanding of patient safety may be improved in several ways. Simulation-
based learning is one such approach. In a secure setting without the threat of endangering patients,
simulation-based learning gives nurses and midwifes the chance to practice their abilities (WHO, 2019).
Utilizing continuing education programs is another tactic. Through continuing education courses, nurses
and midwifes have the chance to learn about new advancements in patient safety and how to use them in
their clinical work, improve communication with patients and attendants, and enhance the organizational
atmosphere for patient safety (Steven et al., 2014; WHO, 2019).

As a result, it's critical to evaluate the state of nurses' and midwifes’ knowledge, attitudes, and practices
concerning patient safety and pinpoint the variables that influence them. Increasing nurses' and midwifes’
competency and performance in delivering safe and high-quality care for patients with various needs and
conditions, will aid in the design and implementation of successful interventions. This study aims to
explore the knowledge of nurses and midwifes regarding patient safety at the St. Gregory Catholic
Hospital.

1.2 Research problem

The acceptance of patient safety as a crucial problem in the healthcare industry is growing, and the rise in
the number of patient safety events presents a challenge to hospital administration. It affects both nations
with mature economies and those that are emerging economically on a global scale. (Dabi et al., 2021). A
key element in assuring the provision of high-quality and safe healthcare is nurses' and midwifes’
awareness of patient safety. Having sufficient knowledge in this area enables nurses and midwifes to
recognize and take precautions against hazards, lessen medical mistakes, and enhance patient outcomes.
However, in the complicated healthcare system, nurses and midwifes play several functions and are
primarily responsible for patient safety. It has been demonstrated that the influence of nurses' and
midwifes’ personal and professional beliefs and attitudes on their constancy in adhering to patient safety
is more significant than the influence of their workload (Vaismoradi et al., 2020). Furthermore, despite
having sufficient awareness of patient safety problems, nurses and midwifes may fail to put that
information into practice (Alesawi et al., 2017). According to Wake et al. (2021), Patient safety is a
medical specialty that emerges when healthcare systems become more complex and patient harm in
healthcare facilities rises sharply.

Even though patient safety education is valued, there are regional and institutional variations in the
programs' depth, breadth, and consistency. This variation may result in differences in nurses' and
midwifes’ knowledge and skills, making it more difficult for them to successfully support patient safety
measures (Konlan & Shin, 2022). According to Aveling et al. (2015), because low-income nations are
particularly affected by resource limitations and inadequate governance frameworks, there is consistency
in the statements of health professionals in many circumstances. The uneven use of evidence-based
patient safety measures can be attributed to factors including lack of knowledge, time constraints, and
insufficient resources (Pitsillidou et al., 2021). Patient safety may be jeopardized if nurses and midwifes
are not always fully equipped to use these complicated devices (Altmiller & Pepe, 2022). To improve
patient safety outcomes in the digital era, it is crucial to look at how technology is affecting nurses' and
midwifes’ understanding of patient safety and to come up with effective techniques for incorporating
technology education into nursing and midwifery curricula and professional development programs.

As a result, it's crucial to evaluate the state of nurses' and midwifes’ knowledge, attitudes, and practices
about patient safety and pinpoint the variables that influence them. To increase nurses' and midwifes’
competency and performance in delivering safe and high-quality care for patients with various needs and
conditions, this will assist to create and execute effective interventions. However, there is a lack of studies
on this topic in St. Gregory Catholic Hospital Gomoa Buduburam in Central Region Ghana. This study
aims to address this gap by researching nurses and midwifes working at this hospital. The study seeks to
explore the knowledge of nurses and midwifes towards in-patient safety at the St. Gregory Catholic
Hospital.
 1.3 Objectives of the study

1.3.1 General objective

To assess the knowledge of nurses and midwifes towards in-patient safety at the St. Gregory Catholic
Hospital.

1.3.2 Specific objectives

Specifically, the study seeks to;

1. To determine the level of knowledge of nurses and midwifes towards in-patient safety at the St.
Gregory Catholic Hospital.
2. To identify the sources of knowledge that nurses and midwifes use to provide in-patient safety at
the St. Gregory Catholic Hospital.
3. To explore the factors that influence the knowledge of nurses and midwifes towards in-patient
safety at the St. Gregory Catholic Hospital.

1.4 Research Questions

1. What is the level of knowledge of nurses and midwifes towards in-patient safety at the St.
Gregory Catholic Hospital?
2. What are the sources of knowledge that nurses and midwifes use to provide in-patient safety at
the St. Gregory Catholic Hospital?
3. What are the factors that influence the knowledge of nurses and midwifes towards in-patient
safety at the St. Gregory Catholic Hospital?

1.5 Significance of the Study

The study's conclusions will guide nursing and midwifery practices in healthcare facilities, point out areas
that need to be improved and serve as a foundation for formulating protocols and recommendations for
nursing and midwifery practices. Nurses and Midwifes, on the other hand, are essential to providing
patients with high-quality treatment, and patient safety is a fundamental component of healthcare
delivery. To enhance the quality of care given to patients, it is crucial to understand the amount of
knowledge that nurses and midwifes have about in-patient safety.

In addition to adding to the body of information on nursing and midwifery practices and patient safety,
the study will also serve as a starting point for future research on related subjects and aid in the creation
of policies and recommendations for enhancing both of these areas of practice. One of the study's policy
recommendations is that hospital administration gives priority to nurses' and midwifes’ education and
professional growth to improve their knowledge and abilities related to patient safety. The analysis will
also show how much more money must be spent by the hospital on enhancing in-patient safety and
nursing and midwifery procedures.

1.6 Organization of the Study

This study is divided into Five (5) parts and is intended to be a paper that. The first chapter is dedicated to
the introduction. This clearly states the study's setting, the problem statement, the research questions, the
objectives, the conceptual framework in which the study was done, and the study's importance. This is
anticipated to serve as an introduction to the remaining study.

The second chapter presents the literature review and describes some of the existing pieces done by other
scholars. This chapter contains numerous citations to important and relevant philosophies. This chapter
also discusses some of the ideas that are guiding contemporary study. It also emphasized some of the
limitations of other people's work, emphasizing the importance of looking at current research.

The third chapter describes the research design and techniques. The research design and research theory
are fully explained here. This chapter also discusses how respondents were chosen and how data was
gathered. It also considers data analysis, tools, and how the processed data will be displayed. This chapter
also discusses the research's ethical considerations.

The fourth chapter contains the findings from the data that was gathered, and the discussions are given.
The findings are provided in table form, with accompanying graphics if needed. It presents the findings
based on the research questions and study objectives. The discussion examines and ties essential concepts
to the study's findings. In addition, it gives an in-depth explanation in response to the topic area and aims.
All plausible reasons for the various connections, as well as the likely link between variables, are
examined in this section. It also revealed the present research's strengths as well as its limits. Suggestions
for future research have been made in a few areas.

In the fifth and last chapter, general conclusions and suggestions are covered. A summary of the research
results as well as suggestions from the lead researcher for additional study is included. Also available at
the document's conclusion are the references and the appendix.

1.7 Conclusion

Safe and high-quality healthcare delivery depends heavily on nurses' and midwifes’ understanding of in-
patient safety. Recent studies have shown that to improve nurses' and midwifes’ understanding of and
involvement in in-patient safety measures, there is a need for ongoing educational interventions,
organizational support, and a supportive safety culture. Healthcare organizations may encourage nurses
and midwifes to actively contribute to in-patient safety by filling in the identified gaps and applying
evidence-base
CHAPTER TWO

LITERATURE REVIEW

Nurses and Midwives Knowledge on In-Patients Safety

The second chapter will provide significant research on the goals. Information pertinent to the study's
subject was the focus of this review. It also brought to light some of the gaps in the knowledge of nurses
and midwifes towards in-patient safety at the St. Gregory Catholic Hospital, in the Gomoa East District
Hospital, about in-patient safety. A literature analysis was conducted to particularly explore the level of
knowledge of nurses and midwifes towards patient safety, sources of knowledge that nurses and midwifes
use to provide in-patient safety, and factors that influence the knowledge of nurses and midwifes towards
in-patient safety at the St. Gregory Catholic Hospital, Gomoa Buduburam in the Central Region of
Ghana. Articles from databases including Research Gate, PLOS ONE, HINDAWI, CINAHL, PUBMED,
FREEFULL and Google Scholar were used to construct this review. The literature review comprises an
introduction, a conceptual review, a theoretical review, an empirical assessment of the current literature,
and a summary of the literature. It has been organized according to numerous theme headings to make it
easier to read. The theoretical overview discusses key concepts related to patient safety. Beginning with
the conceptual review first appearing in the literature, and then following, the theoretical review will be
focused on assessing research throughout time based on the aims. The development of new testable
hypotheses, the identification of existing ideas, their linkages, and the depth of their research are all
facilitated by theoretical literature studies. The study's approach is demonstrated in the conceptual
framework for the key ideas. To answer the specific research question, empirical papers will be included
in the empirical review.

Research conducted study to investigate nursing and midwifery students' patient safety knowledge and
competencies in the classroom and clinical settings and its predictors. The data of this cross-sectional
study were collected from 318 nursing and midwifery students studying at the health sciences faculty of a
state university between November and December 2021, using a descriptive information form and the
Health Professional Education in Patient Safety Survey. Number, percentage, mean, standard deviation,
minimum and maximum values were calculated in the data analysis, and independent-samples t test, one-
way ANOVA, and regression analysis were used. Results shows that Nursing students' mean scores of the
Health Professional Education in Patient Safety Survey were 3.88±0.50 in the classroom, 3.78±0.52 in the
clinic and 4.05±0.48, 3.98±0.49 in midwifery students, respectively. Midwifery students' classroom and
clinic mean scores were statistically higher than nursing students' mean scores (p=0.002; p=0.001).
Moreover, there were statistically significant differences between nursing and midwifery students' mean
scores in the 2 dimensions and all sub-dimensions except for the "Culture of safety" sub-dimension
(p<0.05). Finally, it was determined that the variables of students' age, grade, department and patient
safety competency level affected students' patient safety knowledge and competencies. Study concluded
that Nursing and midwifery students' perception of patient safety knowledge and competencies were
found to be above average.

Conducted study to examine the barriers hindering nurses from reporting medication
administration errors in the hospital setting. Independently assessed the quality of all the
included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.Result showed
that Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes
and subthemes identified as barriers to reporting medication administration errors after the
integration of results from qualitative and quantitative studies were: organizational barriers
(inadequate reporting systems, management behaviour, and unclear definition of medication
error), and professional and individual barriers (fear of management/colleagues/lawsuit,
individual reasons, and inadequate knowledge of errors).study concluded that Providing an
enabling environment void of punitive measures and blame culture is imperious for nurses to
report medication administration errors. Policymakers, managers, and nurses should agree on a
uniform definition of what constitutes medication error to enhance nurses’ ability to report
medication administration errors.

Study was conducted to determine the level of safety of the pharmacotherapy process at the
stage performed by nurses and midwives by indicating the key risk factors affecting patients’
safety.A group of 1276 nurses and 136 midwives in Poland participated in the study. The survey
was conducted in the period from May 2019 to August 2019. The original Nursing Risk in
Pharmacotherapy (NURIPH) tool was used.Result showed that The Cronbach alpha coefficient
was 0.832. The low legibility of the medical orders (item 1) was indicated as the highest risk. A
mean of 4.50 means that this factor’s significance is assessed between “very significant” and
“significant.” The communication between physician, nurse and midwife, time pressure, and
work organization were also rated high (Items 2, 3, and 4). The averages for these factors are
higher than 4, so their evaluation is more than “significant.”.Study concluded that Nurses and
midwives involved in the pharmacotherapy process are exposed to many ergonomic factors
triggering risk. A huge problem is the lack of readability of medical orders, which may be a
factor triggering a medical error.

Globally, nurses are increasingly employed post-retirement, with task-shifting to nurses with
lower competencies, a lack of knowledge being a barrier, all of which could lead to medication
errors.Nurses (N=123) working in 28 LTCFs in the Western Cape province, South Africa. A
quantitative non-experimental, cross-sectional descriptive design was used. The LTCFs were
divided into funded (state-subsidised) and private (for profit) facilities using a stratified sampling
method and each stratum thereafter randomised to obtain equal samples from each stratum. Self-
administered questionnaires with close-ended statements were used, and statistical software
(SPSS version 27) to perform descriptive and inferential analyses.Respondents, (27%), had more
than nine years of experience, with 15.8% aged 61-70 years; and 3.5% aged 71-80 years. Some
were 'very inexperienced' in computer use (29.3%), 35% received medication training longer
than five years ago, and n=28 nurses administered medication outside their scope of practice.
The highest sources of job pressure were an increase in workloads (75.6%), being under stress
(42.3%), and being overworked (39.0%).The aging nursing workforce, although experienced,
found the job demands, paperwork, and technology barriers. Outdated training and delegating
medication administration to lower categories of nurses can lead to medication errors.

2.1 Historical Review

2.1.1 Definition of patient safety

According to the World Health organization, patient safety is a health care discipline that emerged with
the evolving complexity of healthcare systems and the resulting rise of patient harm in health care
facilities. It aims to prevent and reduce risks, errors, and harm that occur to patients during the provision
of health care (WHO, 2019). Patient well-being depends on patient safety, which is a vital part of high-
quality medical care. Also, National Health Service defines patient safety as “about maximizing the
things that go right and minimizing the things that go wrong”. However, patient safety is more than just
the absence of damage and mistakes. By encouraging a culture of continuous improvement, learning, and
responsibility, it seeks to enhance healthcare outcomes. It places a strong emphasis on the value of
coordination, cooperation, and teamwork among medical staff, patients, and their families. Implementing
evidence-based practices, standardizing procedures, and utilizing technology to improve the dependability
and quality of treatment are all part of patient safety. According to Health Care Compliance Association,
“patient safety is a discipline in the health care sector that applies safety science methods toward the goal
of achieving a trustworthy system of health care delivery. Patient safety is also an attribute of health care
systems; it minimizes the incidence and impact of, and maximizes recovery from, adverse events.”

2.1.2 Global Patient Safety Challenge

The World Alliance for Patient Safety's Global Patient Safety Challenge is an initiative that combines the
WHO Guidelines on Hand Hygiene in Health Care with ongoing efforts on blood safety, injection, and
immunization safety, safer clinical procedures, and safe water, sanitation, and waste management
(WAPS, 2005). The identification and prioritizing of particular patient safety issues that demand attention
and improvement is a crucial part of the Global Patient Safety Challenge. These key topics are supported
by in-depth investigation, supporting data, and analysis of global healthcare statistics. They act as focal
points for focused actions and initiatives aimed at improving patient safety on a worldwide basis. The
initiative finds a patient safety burden that poses a major health risk, develops frontline solutions, and
collaborates with nations to disseminate and execute the treatments (WHO, 2017). The Global Patient
Safety Action Plan offers countries a framework for creating their national action plans on patient safety
as well as for coordinating current strategic tools for enhancing patient safety in all clinical and
healthcare-related contexts (WHO, 2021). The objective and strategic direction of this international
program, which aims to cut the degree of severe, preventable damage associated with pharmaceuticals by
50% over the following five years, globally, are outlined in the WHO's Global Patient Safety Challenge:
Medication Without damage booklet (WHO, 2017). This initiative seeks to enhance medication practices
throughout the healthcare system in recognition of the enormous impact that prescription mistakes have
on patient safety. The need for thorough medication management systems, good communication, and
patient involvement in medication usage are emphasized.

2.1.3 Elements of Patient Safety

With the growing complexity of healthcare systems and the consequent increase in patient damage in
healthcare facilities, the field of patient safety has become more important in medicine. It seeks to avoid
and minimize patient risks, mistakes, and injuries that may arise during the delivery of medical treatment
(WHO, 2019; WHO, 2022). The World Health Organization (WHO) has identified 12 elements of patient
safety which include: culture, communication, medication safety, falls prevention, infection prevention
and control, clinical handover, patient identification, clinical deterioration, escalation response,
recognition and response to acute illness, surgical safety, and maternal and new-born safety (WHO,
2019).
 2.2 Conceptual Review

A conceptual framework is described as a collection of carefully phrased and arranged concepts that serve
as a framework, rationale, and procedures for decisions. Word models are typically used to abstractly
express these ideas. It accomplishes it in a form that is easy to remember and use by presenting the
important ideas, variables, and the underlying relationships between them (Brady et al., 2020). According
to Adom et al. (2018), a conceptual framework is also described as a collection of overarching concepts
and principles that are drawn from relevant disciplines of study and utilized to direct future presentations
of the research.

Patient safety is a dependent variable that measures how well medical procedures and systems are set up
to protect patients from harm while under treatment. The three independent variables are the source of
knowledge, level of knowledge, and factors influencing knowledge. Source of knowledge refers to the
various ways or channels through which healthcare professionals can learn about patient safety; level of
knowledge describes the depth of understanding and familiarity that healthcare professionals have with
patient safety principles, practices, and guidelines; and factors influencing knowledge cover the variables
that can affect the learning, remembering, and applying of knowledge.

The knowledge level is influenced by the knowledge source. The degree of patient safety knowledge is
influenced by a variety of sources, including formal training programs, research literature, peer
interactions, and venues for experience-sharing. The knowledge and skills of nurses and midwifes in
handling patient safety concerns in actual healthcare settings. To keep current on the most recent research
results, best practices, and emerging trends in patient safety, nurses and midwifes can read this literature.
It is a useful source of information for informing choices and enhancing patient care. The availability,
applicability, reliability, and use of different information sources have an impact on the amount of
knowledge that healthcare professionals gain. Through years of experience, nurses and midwifes gain
knowledge about typical dangers, difficulties, and tactics for enhancing patient safety. Nurses and
midwifes combine their academic knowledge with real-world application through clinical experience,
enabling them to make educated decisions and judgments in challenging patient care situations.
Healthcare practitioners can learn about systemic problems, communication failures, and possible safety
risks via patient comments that may go unreported from the provider's viewpoint.

Organizational culture, educational support, training programs, teamwork, communication, and the
accessibility of resources are just a few examples of the many variables that affect knowledge. The degree
of knowledge among healthcare personnel is raised by favorable variables such as a supportive corporate
culture that prioritizes patient safety, extensive educational assistance, efficient training programs,
teamwork, and open communication. Lower levels of knowledge might result from negative
circumstances that impede the acquisition and application of information, such as scarce resources, a lack
of educational assistance, a culture that is hierarchical or blame-oriented, poor collaboration, or
communication gaps.

A culture of safety, collaboration among many healthcare stakeholders, and the development of policies
are all actively promoted by nurses and midwifes with an integrated level of expertise. To guarantee that
patient safety is integrated into all facets of healthcare delivery, this level encompasses policy creation,
organizational culture, and inter-professional collaboration. Patient safety results are directly impacted by
nurses' and midwifes’ knowledge levels. Higher levels of knowledge are linked to improved patient
outcomes, enhanced risk identification, better execution of preventative interventions, and better
adherence to patient safety standards. On the other hand, insufficient implementation of patient safety
measures, medical mistakes, impaired patient safety, and adverse events may result from a lack of
understanding. By performing safety audits, putting error-prevention techniques into action, and leading
safety improvement efforts, one may put theoretical knowledge into practice. Nurses and midwifes obtain
awareness from a variety of information sources, such as medical literature, clinical recommendations,
and clinical experience. These resources offer knowledge on the core practices and concepts of patient
safety that are crucial for developing a climate of safety and avoiding harm.

Nurses and Midwifes

Source of Knowledge
 Clinical Experience
 Patient feedback
 Healthcare Literature

Patient Safety
Factors Influencing
Knowledge
 Resource Availability
 Education and training
 Level of Knowledge
 Awareness
 Application
 Integration

Figure 2. 1 Conceptual Framework (Author’s Creation)

2.3 Theoretical Overview

These theories offer conceptual frameworks for comprehending the variables affecting nurses' and
midwifes’ knowledge and conduct concerning in-patient safety. They aid in examining the cognitive,
social, and organizational factors that influence nurses' and midwifes’ expertise, perspectives, and
behaviours in fostering in-patient safety. The following theories were found relevant to the study; health
belief model, social cognitive theory, diffusion of innovation theory, theory of planned behaviour, and
organizational culture theory (Bishop et al., 2015; Kieft et al., 2014; Abdelaliem & Alsenany,
2022;Alanazi et al., 2022;Weaver et al., 2013).

2.3.1 Health Belief Model

According to Abraham & Sheeran, (2015), the Health Belief Model, people's behaviours connected to
their health are influenced by their beliefs about various health-related topics. This approach may be used
to investigate nurses' and midwifes’ perceptions of patient safety with their understanding of patient
safety. It investigates how seriously they take patient safety concerns, how vulnerable they think they are
to making mistakes, how valuable they think following safe procedures is, and what obstacles they think
they face in doing so. (Bishop et al., 2015). To address particular hurdles and emphasize the significance
of patient safety in their practice, interventions and training programs can be specifically adapted by
comprehending nurses' and midwifes’ attitudes and perspectives.
2.3.2 Social Cognitive Theory
According to Social Cognitive Theory, conduct is shaped by observational learning, self-efficacy, and
result expectancies (Manjarres-Posada et al., 2020). This theory explores how nurses and midwifes learn,
grow, and use patient safety procedures when it is applied to nurses' and midwifes’ understanding of
patient safety. Nurses and Midwifes gain knowledge by observing their co-workers, interacting with the
healthcare setting, and increasing their confidence in their ability to follow safe procedures. Promoting
the incorporation of patient safety information into everyday practice may be done by boosting self-
efficacy and rewarding patient safety actions (Kieft et al., 2014).

2.3.3 Diffusion of Innovation Theory

The Diffusion of Innovation Theory investigates how innovations in social systems like as ideas, habits,
or technology propagate (Dearing & Cox, 2018). This theory aids in identifying several nurse and
midwife adopter groups in the context of nurses' and midwifes understanding of patient safety. While
some nurses and midwifes may be more open to change than others, some are early adopters who rapidly
accept patient safety procedures. The elements that affect nurses' and midwifes adoption of patient safety
knowledge and practices may be understood to build solutions that are specifically designed to promote
the adoption of patient safety principles by all nurses and midwifes (Abdelaliem & Alsenany, 2022).

2.3.4 Theory of Planned Behaviour

According to the Theory of Planned activity, a person's attitude, subjective norms, and perceived
behavioural control all have an impact on their intention to engage in an activity (Kan & Fabrigar, 2017).
This theory investigates nurses' and midwifes’ attitudes toward patient safety procedures, social forces
that determine their behaviour (such as the influence of superiors or co-workers), and their perceived
power over putting patient safety measures into practice in the context of nurses' and midwifes’
knowledge of patient safety. Increasing nurses' and midwifes’ perceptions of control, addressing common
misunderstandings, and promoting healthy social norms can all help nurses and midwifes incorporate
patient safety information into their routine practice (Alanazi et al., 2022).

2.3.5 Organizational Culture Theory

According to Büschgens et al. (2013), the common values, beliefs, customs, and practices that exist inside
an organization are the subject of the organizational Culture Theory. This theory places a strong emphasis
on how corporate culture affects nurses' and midwifes’ performance and conduct. Nurses' and Midwifes’
understanding of and adherence to patient safety measures can be greatly influenced by the facility's
culture, which may include leadership styles, communication patterns, and support for patient safety
efforts. Nurses' and Midwifes’ expertise and dedication to patient safety may be improved by fostering a
culture that values and prioritizes patient safety, encourages open communication, and provides the
appropriate tools (Weaver et al., 2013).

2.4 Empirical Literature Review

2.4.1 Knowledge of Nurses towards Patient Safety

In Jeddah Eye Hospital, a study conducted by Alesawi et al. (2017) to assess nurses' knowledge
and practices related to patient safety. Findings from the study indicated that practically all nurses
(93.3%) possessed knowledge at an average level, but only 6.6% of the sample under observation had
practiced their profession to a competent level. Similarly, the majority of participants (60.7%) agreed that
patient safety is important, and more than half of participants (52.7%) self-rated their general knowledge
of patient safety as being on a good level compared to 27.3% for the particular knowledge concerns score
(Almaramhy et al., 2011). Again, with an emphasis on systems rather than individual responsibility, over
60% of the participants claimed that reporting adverse events enhances patient safety. In Western
Lithuania, a study conducted by Brasaite et al. (2017) indicated that relatively a poor degree of safety
awareness, especially when it comes to understanding patient safety in general. Additionally, Cheng et al.
(2020) affirmed that 12.76 out of a possible 14 points was the average score for understanding patient
safety reporting. The results from a study conducted in Iran by Najafi Ghezeljeh et al. (2022) revealed the
score for patient safety knowledge improved by 0.238 points each year of knowledge age and declined by
1.392 points for untrained nurses compared to the base (trained). According to D’Sa & D’Souza, (2022),
nurse awareness and practice were found to be poorer in hospital II, which was not recognized by NABH,
than in hospital I, which was accredited by NABH, for the majority of characteristics relating to patient
rights to access and safety. In every category of the examination of safety attitudes, nurses performed
statistically considerably worse than doctors. In contrast to the employees working in medical wards, the
surgical ward staff scored higher in terms of patient safety. In addition, good working circumstances and
productive cooperation might influence how the staff feels about patient safety (Malinowska-Lipień et al.,
2021). Findings showed that the registered nurses had a clear understanding of patient safety, which they
defined as assisting those with severe mental illness in regaining and maintaining health through
appropriate care, respecting their autonomy, and avoiding compulsion (Sundin et al., 2015).

From the Sub-Saharan perspective, a study was conducted in Asella Referral and Teaching
Hospital, Ethiopia among 172 nurses to assess knowledge, attitude, practice, and associated factors
towards patient safety among nurses working. Findings from the study indicated that, the nurse’s level of
good knowledge, positive attitude, and good practice towards patient safety was 58.7%, 52.9%, and 50%
respectively (Dabi et al., 2021). Similarly, in the same country, Adal et al. (2023) indicated that about
248 (58.8%) and 264 (62.2%) of the nurses had good knowledge and practice, respectively. Again, a good
level of knowledge was discovered in roughly 48.4% of the respondents. Similarly, 56.1% of respondents
had a favorable opinion of patient safety (Biresaw et al., 2020). Notably, 83% of those surveyed said they
knew a lot about the PSI reporting and learning criteria, but 98% thought little of how they were being put
into practice as reported in KwaZulu-Natal (Gqaleni & Mkhize, 2023). In a study conducted in Cairo, the
Calculated attitude score was somewhat higher than the calculated influence score, which was followed
by the calculated knowledge score (median values were 4.25, 3.1, and 2.5, respectively). However,
physicians from various disciplines in the college of medicine are found to have a more favourable
attitude toward patient safety than influence and knowledge (Asem et al., 2019).

From the Ghanaian perspective, findings revealed a score of 62.6 percent, which is somewhat
above average for nurses' expertise in triage. For nurses working in emergency departments, workshops,
and in-service training should be conducted, then they should regularly engage in CPD to enhance this
(Afaya et al., 2017). Likewise, at the University of Ghana, most respondents (97.5%) had a moderate
knowledge of patient safety (Konlan & Shin, 2022).

2.4.2 Sources of Knowledge That Nurses Use to Provide Patient Safety

The term "sources of knowledge" refers to the different resources, sources, and channels that people use
to learn about and comprehend patient safety. Nurses' sources of knowledge are the places they go to get
information, proof, and expertise to better comprehend patient safety practices and principles in the
context of healthcare and patient safety (Kim & Seomun, 2023; Mansour et al., 2018).

A descriptive correlational design was conducted among 539 Jordanian to explore the sources of
knowledge Jordanian registered nurses use during their practice. Results revealed that the knowledge
acquired during nursing education, individual nursing experience over time, lessons learned from
providing care to patients, knowledge gained from conversations between doctors and nurses about
patients, and information from policy and procedure manuals are the top five sources used by Jordanian
registered nurses (Al-Ghabeesh et al., 2013). However, Kim & Seomun, (2023) demonstrated that five
topics made up the detailed knowledge structure: patient, avoidable patient harm, practice, mistake, and
environment. It included risk assessment for the characteristics of patients, the patient's surroundings, and
nursing practice, as well as risk management through knowledge-based nursing practice. Similar to this,
the mind lines are based on clinicians' synthesis of information from different sources to provide
individualized healthcare, and they are drawn from a variety of sources, including the clinicians'
experience, education, advice from others, patients' perspectives, professional sources, colleagues,
infrastructure, and opinion leaders (Brenne et al., 2022). A systemic review conducted by Mlambo et al.
(2021), the review revealed thatthe improvement of nurses' understanding and practice of patient safety
was greatly helped by continuing education programs including workshops, seminars, and online courses.
However, it was shown that nurses' capacity to deliver safe care is positively impacted by continued
professional growth through continuing education. Cheikh et al. (2016)affirmed that Medical schools
(37.7%), the general culture (25.8%), experience (50.5%), and the media (22%), according to health care
practitioners, were the main sources of knowledge on safety culture. In a study conducted in Korea, it was
indicated that patient safety knowledge, attitudes, and abilities among nursing students are improved via
synchronous online patient safety education (D. B. Cho et al., 2022). According to Fossum et al. (2022),
to guide nurses' clinical practice, peers were rated as the most reliable source of knowledge. But now, the
top four most utilized information sources are computers and reference books. Similarly, Yoo & Kim,
(2017) acknowledge that nurses' acquisition of patient safety knowledge was facilitated by an effective
organizational culture that prioritized patient safety and offered a supportive learning environment. In
German, it was demonstrated that nurses' understanding of patient safety has been affected favourably by
inter-professional teamwork including healthcare workers from several disciplines. Additionally,
cooperative actions promoted a thorough comprehension of patient safety concepts through shared
learning experiences and multidisciplinary cooperation (Dinius et al., 2020).

From the perspective of African countries, an integrative study indicated that pre-service
education programs were critical in giving nurses the basics of patient safety knowledge. But there were
differences in the breadth and depth of patient safety information among various academic institutions
(Bvumbwe & Mtshali, 2018). According to Brekelmans et al. (2016), nurses have the chance to refresh
their knowledge and abilities in patient safety through CPD programs. Nurses' competence, confidence,
and adherence to patient safety practices were found to be favourably impacted by continuous learning
through CPD. However, difficulties such as restricted access to CPD opportunities and budgetary
limitations were noted, underlining the need for more support and money to be invested in CPD
programs. The knowledge and abilities of nurses in patient safety were also improved via simulation-
based training. Nurses might practice clinical decision-making, cooperation, and communication in a
secure setting by using simulation situations (Crowe et al., 2018).

In the Ghanaian perspective, Adu-assiamah, (2022) affirmed that structured training, problem-based
learning, reflective practice, and clinical mentoring may all be used to improve knowledge in nursing.
Carpers' ways of knowing, however, can serve as a useful roadmap for nursing knowledge
advancementOfei et al. (2020) affirmed that fostering a culture of safety, providing tools and mentorship,
and fostering nurse supporting and transformational leadership styles all improved patient safety results.
Nurses were more aware of patient safety principles and more committed to putting those values into
practice. Similarly, nurses thought that the teaching hospital's patient safety culture was largely favorable,
with good collaboration and communication. However, there was room for development in the areas of
error reporting, organizational learning from mistakes, and management support for patient safety
measures. The results showed that the Ghanaian healthcare system needs ongoing work to develop its
patient safety culture (Alhassan et al., 2022).

2.4.3 Factors That Influence the Knowledge of Nurses towards Patient Safety
Nurses' attitudes toward patient safety reflect how they feel about the significance and value of patient
safety, while their knowledge of the principles and practices that avoid patient harm throughout the
delivery of healthcare reflects how well they are aware of such principles and practices (Vaismoradi et al.,
2020; Biresaw et al., 2020)

An international review was conducted by Vaismoradi et al. (2020) to provide a systematic review of the
international literature, synthesize knowledge and explore factors that influence nurses’ adherence to
patient-safety principles. Results from the study indicated that Nurses' adherence to patient-safety
standards was impacted by patients' engagement, healthcare professionals' knowledge and attitudes,
collaboration by nurses, proper equipment and electronic systems, education, regular feedback, and
uniformity of the care process. Another study demonstrated that nurses' attitudes toward patient safety
were significantly influenced by their educational background, professional experience, and attendance at
patient safety training sessions (Salih et al., 2021). A study by Konlan & Shin, (2022), found that level of
education, professional category, number of hours worked each week, involvement in a patient safety
program, disclosure of adverse events, openness in communication, organizational learning, teamwork,
physical workspace environment, feedback about error exchange, and support from hospital management
were all factors associated with patient safety. A study conducted in South Korea reported that, although
cooperation, leadership, and ongoing learning in the nursing unit were significant variables impacting
registered nurses' safety competency, the correlations of these characteristics to registered nurses'
attitudes, abilities, and knowledge about patient safety were diverse (S. M. Cho & Choi, 2018). Similarly,
there is a connection between nurses' understanding of patient safety and how they store, order, and
record medications as well as how they deliver and monitor those medications. To maintain patient safety,
nurses are expected to plan and regulate their behaviors when managing medicines in the hospital. They
are also expected to review drug management implementation in the inpatient wards (Rachmawati, 2021).
Also, Abduh Saaid et al. (2020) notated that the nurses' management of implementing global patient
safety goals using the Plan to Do Check Act (PDCA) model and patients' safety culture showed a highly
statistically significant difference with a substantial positive correlation impact.

In Ethiopia, Dabi et al. (2021)showed that knowledge of patient safety was strongly influenced by
factors such as working in the operating room unit, learning about patients' needs during initial education,
and learning about patients' needs during continuing education. Adal et al. (2023) in Ethiopia found
nurses with an MSc degree were twice as likely as and three times more likely than those with a
certificate to have strong knowledge and practice. According to Biresaw et al. (2020), training and
information about patient safety during continuing education demonstrated a positive and significant
association with both the knowledge and attitude of nurses and is essential to implement appropriate
interventions and to enhance the general knowledge and attitude towards patient safety and the standard
of healthcare. Similarly, in Oman, Ammouri et al. (2015) indicated that patients were seen as being safer
overall by nurses who perceived higher supervisor or management expectations, feedback and
communications regarding errors, teamwork across hospital units, and hospital handoffs and transitions.
Nevertheless, nurses who felt that there was greater communication and collaboration inside the units, as
well as more feedback, reported more incidents. Additionally, nurses who worked at teaching hospitals
and had more experience had a more positive impression of the culture around patient safety. A multi-
level modeling approach conducted by Kirwan et al. (2013) reported that it was discovered that
characteristics like the ward practice environment and the percentage of nurses with degrees had a
considerable influence on safety results, especially at the ward level. The study's further findings
suggested that ward-level nurse characteristics such as nurse education level and the work environment
should be acknowledged and managed as significant influencers on patient safety. However, in Sub-
Saharan Africa, variables including restricted access to education and training, inadequate funding,
organizational culture, leadership support, and inter-professional cooperation play a significant role in
influencing nurses' understanding of and use of patient safety procedures. It stressed the significance of
addressing these problems with focused interventions and developing a welcoming atmosphere that
encourages ongoing learning and adherence to patient safety guidelines (Geese & Schmitt, 2023).

A study conducted in KwaZulu-Natal demonstrated that the unit in which you are working and the time of
day were variables linked to your evaluation of how well you knew patient safety implementation
reporting and learning standards (Gqaleni & Mkhize, 2023).But there was a strong correlation between
understanding of patient safety reporting and age, job position, and work experience (Cheng et al., 2020).
According to Mahmoud et al. (2023), the following barriers to the effective use of patient safety learning
systems have been identified: inadequate organizational support with a lack of resources; lack of training;
a lack of a strong safety culture; a lack of accountability; flawed policies; a blame-and-punitive
environment; the complexity of the system; and a lack of experience and feedback.

In Ghana, a study was conducted by Tenza et al. (2022) to explore the views of hospital managers
regarding compliance with patient safety culture dimensions in the selected hospitals in the Bono, Greater
Accra, and Upper East regions of Ghana. Findings from the study affirmed that improvements in
personnel and material resources are needed, as well as the adoption of uniform procedures across all of
the nation's healthcare institutions if management is to respond to medical mistakes in a timely and
appropriate manner.

2.5 Conclusion

Patient safety is a health care discipline that emerged with the evolving complexity of healthcare systems
and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors,
and harm that occur to patients during the provision of health care.The Global Patient Safety Action Plan
offers countries a framework for creating their national action plans on patient safety as well as for
coordinating current strategic tools for enhancing patient safety in all clinical and healthcare-related
contexts. The 11 elements of patient safety include culture, communication, medication safety, fall
prevention, infection prevention and control, clinical handover, patient identification, clinical
deterioration, escalation response, recognition and response to acute illness, surgical safety, and maternal
and new-born safety.

The theories aid in examining the cognitive, social, and organizational factors that influence nurses'
expertise, perspectives, and behaviors in fostering patient safety, these include; the health belief model,
social cognitive theory, diffusion of innovation theory, theory of planned behavior, and organizational
culture theory

According to the results, nurses' understanding of patient safety changes depending on the situation.
There is an opportunity for improvement, even if some research suggests that nurses have a fair amount
of expertise. It was discovered that nurses' awareness of patient safety is influenced by factors including
training, education, and experience. To deepen their awareness of patient safety, nurses depend on a
variety of knowledge sources. Formal education, personal nursing experience, lessons learned from
patient care, consultations with physicians, policy and procedure manuals, and information from
colleagues are just a few examples. Patient safety awareness among nurses is impacted by several
variables. These elements include one's educational background, professional experience, participation in
patient safety training sessions, cooperation between healthcare professionals, appropriate technology and
systems, ongoing learning and feedback, organizational support, teamwork, physical workspace
environment, and support from hospital administration.
 CHAPTER THREE

MATERIALAS AND METHODS

Study Design

A quantitative approach and phenomenological exploratory descriptive study design will be

applied, in which nurses and midwives will be interviewed one on one to gain insight on their

lived experience.

Study Site

The study site will be St. Gregory Catholic Hospital. These health facilities will be located

within the Gomoa Buduburam in Gomoa East District of the Central Region Ghana.

Study Variables

The independent variables will be age, gender, educational status, source of information,

monthly income, experience, of nurses and midwives working in St. Gregory Catholic Hospital.

The dependent variables will be knowledge of nurses and midwives regarding in-patients

medication safety.

Study Population

Baumgartner, Strong and Hensley (2002) define a population as the total number of units from

which data can potentially be collected. Usually, this group of target has common features by

which they can be identified and defined. In this study, the target population will be nurses and
midwives working in St. Gregory Catholic Hospital. The total population size for the study will

be taken from the nurses and midwives working inSt. Gregory Catholic Hospital population in

Gomoa East District.

The St. Gregory Catholic Hospital, Gomoa Buduburam is situated in the southeastern part of

Ghana in the Central Region.

Inclusion Criteria

Inclusion criteria are the key features of the target population that the researcher uses to select

participants from the study population (Patino, 2018).

To be included in the study, a participant will be nurses and midwives working in St. Gregory

Catholic Hospital and are willing to participate in the research study and consented to the study.

Exclusion criteria

In contrast to inclusion criteria, exclusion criteria is explained as features of the potential study

participants who meet the inclusion criteria but present with additional characteristics that could

interfere with the success of the study or increase their risk for an unfavorable outcome (Hulley

& Cummings, 2007). For the purpose of this study, the exclusion criteria will be nurses and
midwives who are not interested in the study, nurses and midwives who refused to consent to the

study.

Sample Size Determination

The sample size in this cross-sectional survey was determined by using a single proportion

formula as follows.

n=Z(α2)⁄2p(1−p)/d2

Where: -
n = The required minimum sample size

z = is the standard normal deviate set at 1.96 (for 95% confidence level = is the desired degree
of accuracy (taken as 0.05)

P = Proportion of safety of nurses (assumed to be 20.15%)

n= (1.96)20.20.15(1−0.2015)0.052 n=240

The minimum sample size for this study was 240

Sampling Technique

The target population of this study, nurses and midwives in St. Gregory Catholic Hospital,

Gomoa East district. Simple random sampling technique will be used to select the sample. Non-

probability convinence sampling technique will be used to select the sample.

Data collection tools

The research instrument to be used will be a structured interview guide that will comprise of four

distinct sections. The first section (Section A) will comprise of information on the demographic

data of the respondents, the second section (Section B) will explore the respondents’ knowledge

regarding in-patients medication safety. The questionnaire will be developed with tools and 30

statements used in the literature that will be reviewed in the course of the study.

Pretesting of Data Collection Tools

Pretesting has been explained as a method of making sure that the data collection instrument

work as intended and is understood perfectly by the study 21 participants who are likely to

respond to them (Giles, 1984). Pre-testing provides directions on whether to maintain, change or

modify the questionnaire. 20 of the actual questionnaires will be administered to 20 nurses at

different selected hospitals.

Reliability

Reliability of a study explains the degree to which the results from a measurement procedure can

be replicated without alterations in the procedure (Heale, 2015). The pre-test that will be

conducted will reveal a Cronbach’s Reliability Alpha Co-efficient of 0.8 indicating a higher

standard of reliability for the questionnaire to be used in the study.

Validity
Validity is the extent to which the scores from a measure represent the variable they are intended

to measure. It is also explained as a measure of the accuracy of the findings obtained from a

study (Heale, 2015). The instrument will be valid as it will be able to measure the intended

objectives of the study.

Data collection

During the actual data collection, nurses and midwives who meet the inclusion criteria and did

not meet the exclusion criteria will be approached with a well- structured questionnaire. The

purpose of the study will be made known to the study participants. Thereafter, informed verbal

consent will be sought from respondents before the questionnaires will be administered. The

participants will be given further explanations when necessary and the study participants will be

given the opportunity to back out of the study at any point in time. The responses from the

respondents will be collected over a period of one weeks. Average time spent on each

questionnaire will be 10 minutes.

Data Management and Analysis

The data that collected from the study participants will be coded, entered and analyzed with the

application of IBM SPSS version 27.0. Descriptive statistics will be used to summarize the data

and the results will be presented using percentages and frequency tables.

Ethical consideration

An introductory letter will be sought from the Department of Nursing/Midwifery,KAAF

University College and approval will be sought from the St. Gregory Catholic Hospital Gomoa
Buduburam, Gomoa East District Health Management Team. For the purposes of confidentiality,

the names of participants will not be included in the biographical data that will be collected from

the respondents. Informed verbal consent will be sought from all the participants right before the

questionnaires will be administered. All respondents will be given the autonomy on whether to

participate in the study or not.

GANTT CHART (WORKPLAN)

WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK5 WEEK 6 WEEK

THESIS PROPOSAL

DEVELOPMENT

APPROVAL

ETHICAL

CLARANCE

DATA COLLECTION

DATA ANALYSIS

DISCUSSION,

SUMMARY,

RECOMMENDATION
DISSEMINATION OF

FINDINGS

BUDGET

ITEM AMOUNT (GhC)

STATIONERY

TRANSPORTATION

INTERNET BUNDLES

FOOD

MISCELENEOUS

TOTAL
REFERENCES;

Abdelaliem, S. M. F., & Alsenany, S. A. (2022). Factors Affecting Patient Safety Culture from Nurses’

Perspectives for Sustainable Nursing Practice. Healthcare (Basel, Switzerland), 10(10).

https://doi.org/10.3390/healthcare10101889

Abduh Saaid, B., Abdullah, S. M., & Abo Elmagd, N. S. (2020). Effect of Applying A training Program

about International Patient Safety Goals on Patient’s Safety Culture. Assiut Scientific Nursing

Journal, 8(22), 133–144.

Abraham, C., & Sheeran, P. (2015). The health belief model. Predicting Health Behaviour: Research and

Practice with Social Cognition Models, 2, 30–55.

Adal, O., Hiamanot, Y., Zakir, A., Regassa, R., & Gashaw, A. (2023). Knowledge , Attitude , and

Practice of Nurses Toward the Initial Managements of Acute Poisoning in Public Hospitals of Bahir

Dar City , Northwest Ethiopia 2022 : Cross-Sectional Study.

https://doi.org/10.1177/23779608231157307

Adom, D., Hussein, E., & Adu-Agyem, J. (2018). THEORETICAL AND CONCEPTUAL

FRAMEWORK: MANDATORY INGREDIENTS OF A QUALITY RESEARCH. International

Journal of Scientific Research, 7, 438–441.

Adu-assiamah, S. (2022). Knowledge Development in Ghanaian Nursing Institutions Using Carper ’ s

Ways of Knowing. 9, 1–10. https://doi.org/10.4236/oalib.1109135

Afaya, A., Azongo, T. B., & Yakong, V. N. (2017). Perceptions and Knowledge on Triage of
NursesWorkingin Emergency Departments of Hospitals in the Tamale Metropolis ,. 6(3), 59–65.
https://doi.org/10.9790/1959-0603065965.
Agani Afaya , Kennedy Diema Konlan , Hyunok Kim DoImproving patient safety through identifying

barriers to reporting medication administration errors among nurses: an integrative review 2021 Oct

25;21(1):1156. doi: 10.1186/s12913-021-07187-5.

Anne-Marie Brady 1, Anne-Marie Malone, Sandra Fleming: A literature review of the individual and
systems factors that contribute to medication errors in nursing practice 2009 Sep;17(6):679-97. doi:
10.1111/j.1365-2834.2009.00995.x.

Emerentia C Nicholson, Anneleen Damon:Is medication administration in the elderly influenced by

nurses' demographics in South Africa? 2022 Mar 18:27:1750. doi: 10.4102/hsag.v27i0.1750. eCollection
2022.

Turkiye Klinikleri: Assessing managerial patient safety practices that influence adverse events reporting
among nurses in the Savannah Region, Ghana 2023, Vol 15, Issue 1, p162

World Health Organization. Definitions of key concepts from the who patient safety curriculum guide.
Geneva: World Health Organization, 2011.