Defense Date


Graduation Date

Spring 5-11-2018


Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Alison M. Colbert

Committee Member

James B. Schreiber

Committee Member

Bonnie Dean

Committee Member

Pamela Klauer Triolo


Patient safety culture, patient advocacy, patient outcomes, nurse demographics, nurse tenure


The purpose of the study was to understand relationships between and among patient safety culture, nurse reported attitude toward patient advocacy and key patient outcomes. Nurses play an integral role in patient safety, providing care through constant interaction with the patient and clinical team. Advocating for patients is part of that role; however little research existed that explored how advocacy was related to the safety culture or specific patient outcomes.

A correlational cross-sectional design was chosen for this secondary data analysis. Correlation and regression models were applied to medical/surgical unit data from seven facilities within one hospital system. Sources of data included the patient safety culture survey from the Agency for Healthcare Research and Quality (AHRQ), the Nurses’ Attitudes Toward Patient Advocacy (APAS) Acting on Behalf of Patients (ABP) subscale, the Hospital Consumer

Assessment of Healthcare Providers and Systems (HCAHPS) survey, patient falls and hospital acquired pressure ulcers (HAPU).

Significant findings included a weak to moderate correlation between patient safety culture and attitude toward advocacy, and a moderate negative correlation between safety culture, advocacy and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. Perceptions of experienced medical / surgical nurses within the participant hospitals were overall less positive about the patient safety culture and advocacy than their less experienced peers. These results raised questions as to whether adequate leadership attention was being given to the practice concerns of experienced medical/surgical nurses related to patient safety and advocacy.



Additional Citations

DiCuccio MH. The relationship between patient safety culture and patient outcomes: A systematic review. J Pat Saf. 2015;11(3):135-142.