A Structure Model of Clinical Nurses' Silence on Patient Safety

Purpose: The aim of this study was to establish a hypothetical model on silence regarding patient safety and to verify the model's goodness of fit and hypotheses. Methods: The participants in this study were 330 registered nurses working in tertiary hospitals with over 300 beds. Data were collected between July 1, and August 30, 2017, from nurses who agreed to participate. A covariance structure analysis was performed. Results: The model of fit index was $x^2=59.54$, normed $x^2=2.29$, GFI=.97, AGFI=.93, SRMR=.05, NFI=.99, CFI=.95 and RMSEA=.05. The organizational culture had an influence on patient safety motivation (${\beta}=.26$, p=.003) and attitude (${\beta}=.43$, p<.001). RN-MD collaboration had an influence on patient safety motivation (${\beta}=.33$, p<.001), attitude (${\beta}=.35$, p<.001), and patient safety silence (${\beta}=-.17$, p=.026). Supervisory trust had an influence on patient safety motivation (${\beta}=.26$, p<.001), attitude (${\beta}=.12$, p=.036), and patient safety silence (${\beta}=-.23$, p=.002). Patient safety motivation had an influence on patient safety silence (${\beta}=-.33$, p=.006). The model of patient safety silence explained 36.0% of the variances. Conclusion: This study is meaningful in that it provides basic data for nursing education and program development for rejecting patient safety silence.