Introduction
Hospital nurses play a crucial role in delivering safe and high-quality healthcare services. However, the demanding nature of nursing work, including high patient acuity, heavy workloads, staffing shortages, and emotional demands, can contribute to significant job stress among nurses [1]. Nursing is a stressful profession [2], and it requires providing high-quality care alongside high emotional burdens while facing stressful situations and a wide variety of work stressors [3].
Job stress is the emotional and physical response resulting from perceived imbalances between job demands and available resources [4]. In healthcare, job stress has been extensively studied, and various coping strategies have been identified to mitigate its effects [5]. Excessive stress can have numerous negative impacts, including increased absenteeism and turnover [6], lower job satisfaction, decreased output, decreased ability to make appropriate decisions, weariness at work, reduced effectiveness, and poor standards of patient care [2, 7, 8]. These problems increase the risk of job injuries [9], as studies have shown that job stress directly or indirectly affects the provision of health services [10]. Owing to their duty to provide patients with safe, high-quality care, healthcare workers—primarily nurses—are particularly vulnerable to workplace stressors that can lower their productivity and the standard of care they provide, which may compromise patients’ safety [8]. Furthermore, elevated stress levels increase the likelihood of errors affecting patient outcomes directly or indirectly [2, 11]. Stress at work can be caused by inadequate supervision, unfavorable working circumstances, and a lack of encouragement from coworkers and superiors [12]. Therefore, hospital administrators can increase the caliber of nursing services and their performance by creating plans to enhance the work environment.
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In recent years, there has been growing recognition of the importance of PSC in healthcare organizations. PSC refers to the shared values, beliefs, attitudes, and behaviors that shape the way patient safety is perceived and practiced within an organization [13]. Nursing research has recognized the crucial assessment of specific nurses’ perceptions [14]. The perception result included how a person would react during the procedure [15]. Researchers have reported that people’s viewpoints are influenced by their beliefs, cultures, emotions, experiences [16] and resources [17]. How nurses perceive things while working on the front lines affects how they approach providing care [18]. Moreover, a positive PSC is crucial for preventing medical errors, improving patient care outcomes, and enhancing the overall quality of care [13]. Additionally, to create a supportive environment for patient safety inside the institution, all individuals must maintain executive dedication, good communication, motivated personnel, and shared confidence [19]. Increasing the PSC will help the organization fulfill its long-term commitment to improving quality and patient safety [8].
The relationship between job stress and the perception of PSC is an area of interest among researchers and healthcare practitioners. Previous studies have demonstrated that job stress can negatively impact nurses’ ability to deliver safe care, affect their satisfaction, cause burnout, and may influence their perception of PSC [20, 21]. However, limited research has been conducted on this relationship among hospital nurses in Palestine, where healthcare systems face unique political, economic, and social challenges. The healthcare system of Palestine operates in a complex environment characterized by resource constraints, political instability, and an increased demand for healthcare services [22]. Hospital nurses in Palestine are confronted with numerous stressors, including high patient volumes, limited resources, role ambiguity, and exposure to traumatic events resulting from ongoing conflicts [23]. These stressors can significantly affect nurses’ well-being, job satisfaction, and ability to provide safe and quality care.
Understanding the relationship between job stress and the perception of PSC among hospital nurses in Palestine is crucial for identifying areas of improvement and developing targeted interventions to enhance patient safety and nurses’ well-being. By gaining insights into nurses’ experiences, challenges, and perceptions, healthcare organizations and policymakers can take appropriate measures to address job stressors, improve working conditions, and foster a positive PSC. Developing practical stress management skills can help maintain harmony within organizations [24, 25]. Therefore, this qualitative study aims to explore the factors that influence job stress and PSC among hospital nurses in the North West Bank of Palestine. The results of this research will provide a foundation for future healthcare research and system improvements.
Methods
Design
This qualitative study used a phenomenological approach to explore hospital nurses’ experiences with and perceptions of job stress and PSC. This approach allows for an in-depth understanding of nurses’ subjective experiences and provides rich insights into the complex interplay between job stress and the perception of PSC.
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Sample and sampling technique
A purposive sampling strategy was employed to select participants who could provide rich and insightful data regarding their lived experiences with job stress and patient safety culture within the context of hospitals in the North West Bank, Palestine. This approach was chosen to ensure that the sample included nurses with diverse experiences and perspectives across various hospital units. Purposive sampling is particularly suitable for phenomenological studies, as it allows researchers to focus on participants who have in-depth experiences relevant to the research question.
Sampling criteria
The participants were selected based on the following criteria to ensure a focused and relevant sample. First, participants had to be currently employed as registered nurses in a hospital within the North West Bank, Palestine. Second, they needed a minimum of one year of clinical nursing experience. Third, they should have experience working in a variety of hospital units, including but not limited to medical, surgical, and emergency departments. Fourth, participants needed to express a willingness to share their experiences and perceptions related to job stress and patient safety culture. Finally, special emphasis was placed on including nurses with a master’s degree in nursing due to their potential for providing advanced insights into the complexities of patient safety and nursing management, given their enhanced educational background and potential leadership roles. This focus was also chosen because of the high percentage of nurses with master’s degrees within the Palestinian system.
To ensure diverse representation within the constraints of a small sample size, potential participants were identified from multiple hospital units across the North West Bank. Given the focused nature of the study and the need for in-depth exploration of individual experiences, a purposive sampling strategy was employed to select seven nurses who met the specific criteria. Potential participants were identified through professional networks and direct contact with hospital staff. Invitations to participate were extended to those nurses who met the selection criteria and expressed interest in the study. Data collection continued until thematic saturation was achieved, ensuring that no new themes emerged from the interviews.
Instrument
Semi-structured questions were used in this study. The interviews were conducted until data saturation was reached to explore nurses’ perceptions of PSC and job stress. The semi-structured interview questions were derived from the literature. Examples of the questions can be found in Additional File 1. Before the interviews were conducted, the questions were reviewed with the supervisor and a pilot test. The pilot study was beneficial in assisting the researcher in anticipating potential difficulties and challenges. During the interviews, the researcher used Arabic as the primary language, occasionally switching to English for clarity based on the participant’s preference. The questions were progressively tailored from general to specific.
Data collection
The interviews were conducted in September 2023. The researcher and his assistants traveled between cities to meet the nurses in their area. The interviews were conducted in a private setting outside their workplaces, allowing participants to focus without time or mental constraints. At the start of each interview, the researchers introduced themselves and explained the study’s purpose. The participants received detailed information about the interview process, including its average duration of 28 min. They were assured that their participation would be treated confidentially and anonymously. Additionally, the participants were informed of their right to discontinue the interview at any point. Three interviews were conducted via Zoom for participants’ convenience, using audio-only calls. The remaining four interviews were conducted face-to-face and in private.
Data analysis
The interviews were audio-recorded and transcribed verbatim for analysis, and the transcripts were analyzed via the interpretive description technique. Data transcription was subjected to an inductive thematic analysis [26]. The analyses of qualitative data were based on the six steps of the thematic analysis approach of V Braun and V Clarke [26]: getting to know the data, creating the first codes, combining codes to develop themes, going over themes, giving themes names and definitions, and finally reporting themes.
Results
Seven interviews were conducted face-to-face and via Zoom on the Internet. Each interview lasted 28–40 min. This study was conducted to gain an overview of the participants’ perceptions of PSC and the most common job stressors among hospital nurses and to gain insight into the relationship between them.
Nurses were recruited from the selected hospitals to conduct the semi-structured interviews. When saturation was reached, the interviews were stopped. The researcher selected a diverse group of nurses from various units to represent a variety of perspectives. Male participants represented 42.9%, whereas female participants constituted 57.1%. All the participants were married; more than half of them (57.1%) held master’s degrees in nursing fields, and most of them had more than 11 years of experience (71.4%). The rest of the participants’ characteristics can be seen in Table 1.
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Table 1
Demographic characteristics of the interviewed nurses
Variable | Categories | Number (N) | Percentage (%) |
|---|---|---|---|
Gender | Male | 3 | 42.9 |
Female | 4 | 57.1 | |
Age group | 20 to 29 years | 1 | 14.3 |
30 to 39 years | 5 | 71.4 | |
40 years and above | 1 | 14.3 | |
Marital Status | Married | 7 | 100 |
Resident | Nablus | 2 | 28.6 |
Tulkarm | 2 | 28.6 | |
Jenin | 2 | 28.6 | |
Salfit | 1 | 14.3 | |
Academic Level | Bachelor | 3 | 42.9 |
Master | 4 | 57.1 | |
Experience in Profession | 1 to 5 years | 1 | 14.3 |
6 to 10 years | 1 | 14.3 | |
11 or more years | 5 | 71.4 | |
Total Respondents | 7 | 100% | |
In this qualitative study, we investigated the intricate relationship between job stress and the perception of PSC among hospital nurses in Palestine. Through in-depth interviews and thematic analysis, we uncovered valuable insights into the experiences and perspectives of nurses working in a challenging healthcare environment. Our findings shed light on the multifaceted nature of job stress and identify the factors contributing to its prevalence among nurses. Furthermore, our research highlights how job stress can significantly influence nurses’ perceptions of PSC within their healthcare settings. These results provide a comprehensive understanding of the dynamics at play and offer a foundation for future initiatives to enhance patient safety and the well-being of nurses in Palestine. Our results include six themes, three related to PSC in hospitals (see Table 2): factors affecting PSC and management support, the reporting process, and communication openness. The remaining three themes are related to job stress (see Table 3): job stress-related factors, effects of job stress, and coping mechanisms for job stress.
Table 2
Themes and subthemes related to PSC
Themes | Subthemes and (meaning bearing units) |
|---|---|
Factors Affecting PSC and Management Support | Teamwork |
Staffing and work pace | |
Handoffs and information exchange | |
Management-related | |
Policy implementation and administrative support | |
Reporting Process | Communication about error (staff, management response to error) |
Learning from errors | |
Incident report process | |
Errors impact patient safety | |
Punitive and non-punitive culture | |
Communication Openness | Impact of professional communication on PSC |
Themes on PSC
In the following, we explored the themes with examples from nurses’ words:
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Factors affecting PSC and management support
In this theme, the participants mentioned the most common factors affecting nurses’ perceptions of PSC, which were presented in five subthemes. Most interviewed participants agreed on the importance of teamwork to improve patient safety within and between the units. This reflects their perception of PSC in the domain of teamwork. One of the nurses stated, “Teamwork decreases the workload on senior nurses, which positively affects patient safety” (N5). Another senior nurse said, “The teamwork between departments provides more help as required to maintain patient safety” (N1).
Moreover, nurses agreed that an increase in the number of patients per nurse resulted in a greater workload, which led to more errors and compromised the safety of the patients; for example, one experienced nurse said, “When the staff ratio decreases, patient safety is affected negatively, and if nurses’ number increases, it is better regarding patient safety; it helps prevent falling events and medication time delays” (N1). Another nurse said, “…when nurses’ numbers decrease, that increases workload and puts patients at risk, such as bed sores. As a result, you do not have time to change positions, so this factor is very important for patient safety” (N3).
Furthermore, the nurses expressed their perspectives on the importance of a good and uninterrupted handoff process. They noted that these interruptions might lead to missing information. A nurse said, “When new admissions arrive at the ward at the time of nursing handover, this causes interruptions and makes the nurses transform information fast, leading to missed data that may affect patient safety” (N1). Information missing could also occur between physicians and nurses when communicating information on a patient’s condition. Physicians may also interrupt the nursing handover process to do a round or to check a patient and make new orders. A nurse said, “…doctors sometimes interpret us while handover causes incomplete handover” (N3).
The role of hospital management and administrative support was also emphasized, as participants noted that managerial attitudes, leadership styles, and communication skills affect their perception of PSC. One nurse said, “…inappropriate behavior and stress of the head nurse led to staff stress and affect their work negatively, which may affect patient safety” (N4). Another nurse said, “If the head nurse was stressed, that may affect the nurses and put them under stress, which may lead to errors and may cause medication errors” (N1). This also applies to nursing managers. The participants believed that the leadership style of their nurse leaders and matrons may affect their work, which in turn may affect the safety of patients. One nurse said, “…if the matron is more assertive and restricted regarding the nurse-patient ratio, this increases nurses’ fear, resulting in a negative effect that increases the possibility of errors” (N1).
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The participants highlighted the role of hospital administration in emphasizing PSC. Some hospitals have policies and training programs to prevent errors, and corrective actions are implemented when needed. One of the nurses said, “…in my hospital, after the reported error, they do a policy to address it. For example, high-alert medications are used to avoid further patient harm” (N6). Another one said, “Our hospital focuses on matters related to patient safety. It conducts courses and performance indicators and pays attention to correcting mistakes and learning from them, etc. For example, the patient at high risk of falling wears a yellow bracelet” (N2).
Reporting process
In this theme, participants expressed how they communicate errors, respond to mistakes, learn from them, and how management deals with errors that happen or are reported. Their viewpoints were presented in five subthemes.
The participants expressed how they communicate errors, respond to mistakes, learn from them, and how management deals with errors that happen or are reported. They agreed that critical errors affecting patient safety are reported to their managers or supervisors either verbally or in writing. Additionally, they discuss errors with colleagues to prevent recurrence. One nurse said, “If any nurse faces an error, we alert other nurses in the department during handover and WhatsApp groups to take care of it to avoid reoccurrences of the same error” (N1). However, some participants mentioned that staff may fear punishment when reporting errors, which could hinder communication. One nurse said, “…if an incident is reported to the administration, they may punish the nurse. Sometimes, nurses may not report correctly because we fear punishment” (N6). Conversely, some participants believed that a positive managerial response encourages effective communication about errors. One participant said, “In our hospital, there is a committee for incidents; my head nurse also gives us feedback regarding mistakes and recommendations to improve our practice” (N2).
The majority of the participants mentioned that each reported error provided a learning opportunity. Some mentioned that the administration supports and coaches the learning process. A nurse said, “After a patient falls, we have a policy and recommendations to keep the patient with a companion and not to close the bathroom door with a lock, and our hospital provided the ward with a wheelchair” (N7).
Most participants believed that staff members negatively communicate errors through departments when an error is reported. They also thought that it was taken personally and that they may be blamed. One nurse said, “I worry about the personal repercussions when writing an incident report, and in my work environment, they consider writing an incident report undesirable” (N7). Another one said, “In our hospital, they turn the reporting of the event into personal reasons that are far from professional, and the culture of blame exists” (N5).
This theme also presented the incident reporting process and what happened after, with examples of incidents that affected patient safety. The process of reporting incidents differs in Palestinian hospitals but is usually reported by writing an incident report and referring it to the hospital administration; as a nurse said, “In our hospital, the incident report is sent to the quality committee and administration” (N4). Another one said, “When an error occurs, it is referred to the quality office and then to the committee. The committee provides recommendations to the nursing director, who mostly follows them and requires actions from the nurse. Sometimes, it may be referred to the HR department if the incident is major and causes harm to the patient” (N1).
Some of the events had minor effects or no effect on patient safety. At the same time, others could harm the patient. However, these incidents are reported so that staff can learn from them and prevent their occurrence. One nurse said, “I faced an event of falling off the patient with no harm” (N7). Another said, “…unclear handover led to duplication of medication doses. For example, when a patient is transferred, an incident happened between the ER and the pediatric ward” (N6). On the other hand, some of the errors had a severe effect on patient safety; as a nurse said, “I know an error happened; a nurse administered a D/W of 50% instead of D/W of 5% for a child, which led to brain edema and death” (N6).
Communication openness
The interviewees expressed the importance of professional communication at work. They noted that it is one tool that helps prevent errors and improve patient safety. Professional communication, especially when patient information is exchanged, such as in the nursing handover process, helps prevent errors. A nurse said, “Professional communication prevents missed data or inappropriate handover” (N4). Another said, “It is important that the communication with the patient’s information be professional and clear, which certainly affects the patient’s safety. The more effective the communication, the better we can maintain the patient’s safety” (N7).
Themes on job stress
Table 3 shows the three themes that emerged from the semi-structured interviews related to job stress.
Table 3
Themes related to nurse job stress
Themes | Subthemes and (meaning bearing units) |
|---|---|
Job stress-related factors | Patient-Related: patient’s condition, death and dying, uncertainty concerning treatment |
Colleagues Related: conflict with physicians, conflict with other nurses | |
Workplace and administrative related: shortage of resources, companions, and visitors, lack of support, and workload | |
Effects of job stress | Effect on PSC |
Effects on nurses | |
Coping mechanisms for job stress | Self-related coping mechanism |
Hospital-related coping mechanisms |
Factors of job stress among nurses
As the participants mentioned, many job-related factors increase their stress. Nurses become stressed while they are on duty because some of the patients’ conditions are bad, and their companions frequently ask the nurses about their patient’s status; for example, a nurse said, “…patient’s conditions sometimes stressed me and patients’ companions and visitors” (N3). Moreover, if the patient died, the nurse felt sad; as a nurse said, “…if a child died in my ward, my emotions were affected, and I became stressed” (N6).
In workplaces, nurses may face conflicts with their colleagues, such as nurses and doctors, that increase their stress and affect their duties. One nurse said, “Some doctors put me under stress if they delay in emergencies, for example, when an incompetent doctor is unable to do an urgent intubation” (N5).
Nurses’ stress is also affected by a shortage of resources, companionship, visitors, lack of support, and workload. One nurse said, “If we have urgent admission while no preparation besides a lack of equipment caused me stressed” (N5). Another said, “… the administration does not support us regarding the nurse-patient ratio, which increases our stress and affects our schedule, road condition, and transportation” (N3). Companions and visitors also stress the staff because they frequently ask about and interrupt their duties: “…the visitors caused me to stress and interrupted my work” (N5).
Effects of job stress
The participants agreed that job stress affects both PSC and nurses. Job stress negatively affects nurses’ work. It affects how they concentrate on their tasks with patients. One nurse said, “…stress affects my concentration when providing patient care” (N6). Another one said, “Job stress lowers my concentration and leads me not to do the procedures correctly, which may increase the occurrence of errors” (N4). Furthermore, job stress affects nurses’ psychological status and performance. One nurse said, “…I feel tired, frustrated, and unsatisfied” (N3). Another said, “Stress affects me negatively, and I try to be positive to accomplish my important tasks” (N4).
Coping mechanisms for job stress
Nurses try to cope with job stress via different approaches. However, hospital administrations need to investigate staff stressors and help them cope. Nurses try to cope with their stress through self-produced techniques such as debriefing, tourism, deep breathing, smoking, and others. For example, one nurse said, “Taking a rest and talking with my colleagues make me comfortable and decreases my stress related to work pressure” (N7). Another one said, “I do breathe exercise to decrease stress” (N1).
Moreover, some hospitals are concerned about stress management for their employees, whereas others are not. For example, a nurse said, “Our hospital instructed the nursing staff and required training, reflection, and reinforcement to cope with stresses” (N1). Another said, “…no hospital-related strategies to relieve our stress” (N5).
Discussion
This section delves into the implications of our phenomenological research for understanding nurses’ perceptions and the factors associated with job stress and PSC among hospital nurses in Palestine. Our study identified six main themes: three related to PSC and three related to job stress. These themes are critical for understanding the dynamics between job stress and PSC and highlight areas that need intervention to improve nurses’ well-being and patient safety.
Patient safety culture
Teamwork is integral to a positive PSC. Effective collaboration among healthcare professionals enhances communication, reduces errors, and improves patient care quality. Our findings, which are consistent with studies in Egypt, Korea, Ethiopia, and the United States, emphasize that strong teamwork across units and during handoffs and transitions is crucial for a robust PSC [27‐30]. In Palestine, fostering teamwork is particularly important given the high-stress environment and resource constraints [31]. Additionally, a favorable nursing practice environment has been shown to enhance nurses’ flow at work, which in turn reduces the implicit rationing of nursing care and adverse patient events [32].
High workloads significantly contribute to job stress and negatively impact PSC. Nurses in Palestine often face heavy patient loads and limited resources, exacerbating job stress and hindering their ability to maintain safety standards. Addressing workload issues through better staffing and resource allocation is essential. This is supported by our findings and other studies highlighting the impact of workload on patient safety and nurse well-being [6]. Research suggests that ensuring a supportive nursing practice environment can mitigate the effects of high workload by promoting engagement and reducing job stress [32]. This underscores the importance of creating efficient and supportive work environments that enable nurses to perform their duties effectively, thereby improving patient safety.
Moreover, adequate staffing levels are directly linked to job stress and PSC. Insufficient staffing can lead to burnout and errors, compromising patient safety [33]. Our study supports the need for appropriate staffing to ensure a safe and efficient work environment for nurses. Ensuring adequate staffing is crucial for reducing job stress and enhancing PSC.
Furthermore, open and effective communication is vital for a strong PSC [34], a finding reinforced by our study. It helps identify and address potential safety issues before they escalate. Enhancing communication channels among healthcare professionals in Palestine can mitigate job stress and improve PSC. Effective communication also supports better teamwork and resource management, further enhancing patient safety [3]. Encouraging supervisor-led positive workplace discussions, such as positive gossip, has been found to enhance teamwork and morale, indirectly strengthening PSC [35].
Non-punitive responses to errors are crucial for encouraging error reporting. Our findings indicate that nurses in Palestine have a negative perception of current error reporting practices. To foster a culture that encourages reporting without fear of punishment, hospital administrations must create a supportive environment that prioritizes learning from errors [31]. This shift can significantly enhance PSC by making error reporting a constructive process [36].
Job stress
Similar to other studies, our results show that conflicts among colleagues exacerbate job stress and negatively impact PSC [37‐39]. In Palestine, the lived environment is particularly conducive to stress and anxiety [40]. Healthcare professionals are further affected by working with patients who have anxiety and depression symptoms, such as cancer patients [41, 42]. Promoting a harmonious work environment and implementing effective conflict-resolution strategies are essential. Addressing interpersonal conflicts can reduce stress and improve teamwork, thereby enhancing PSC. Additionally, research highlights that the mistreatment of nurses by patients significantly increases job stress and reduces their ability to engage in compassionate care. Psychological detachment strategies and supportive workplace discussions can help buffer these negative effects [35]. A study conducted on Omani nurses emphasized the high levels of work-related stress experienced by staff nurses, examined their coping mechanisms, and determined the relationship between stress levels and coping methods. A key finding was that the frequency of stress reported by nurses was substantial, reflecting the demanding nature of their profession, which requires maximum attention. Furthermore, nurses predominantly rely on planful problem-solving strategies to manage stressful situations rather than other coping methods [43].
A lack of support from supervisors and peers is a significant stressor for nurses [44]. Providing adequate support systems, including supervision and peer support networks, can alleviate job stress and improve PSC. Support from leaders is critical in fostering a supportive work environment [12]. This finding is further supported by research on decent work environments, which highlights the mediating effects of perceived insider status and psychological well-being on nurses’ work ability. Fostering a sense of belonging and providing psychological support can significantly enhance nurses’ job satisfaction and reduce stress [45].
The emotional and physical demands of nursing, particularly in conflict-affected regions such as Palestine, are substantial. Nurses often deal with traumatic events and high-stress situations, leading to burnout and reduced job performance. In Palestine, stress is overcome by their ability to access health care as a result of Israeli occupation [40]. The implementation of stress-reduction techniques and resilience-building strategies, such as those found in Sumud culture, can help nurses manage these demands [46, 47]. Additionally, improving decent work conditions, including job security and psychological well-being, has been linked to increased work ability and reduced stress among nurses [45].
Comparative analysis with previous research
Our findings resonate with global research on the relationship between job stress and PSC. For example, in Omani hospitals, factors such as the work environment, emotional exhaustion, depersonalization, personal accomplishment, and organizational support significantly affect PSC [48]. This underscores the universal nature of these issues and the importance of context-specific interventions. Additionally, qualitative data from Canadian healthcare organizations revealed similar themes related to incident reporting, management, and the need for leadership support in fostering a “just culture” [49].
Moreover, a systematic review highlighted teamwork and organizational learning as crucial components of patient safety culture (PSC). This underscores the importance of effective collaboration and continuous learning within healthcare settings to improve safety outcomes. Additionally, gender, demographic characteristics, job experience, and staffing levels have been identified as significant influencers of error reporting and safety awareness. These variables should be carefully addressed in future research and interventions to enhance PSC [50].
Finally, the review included 132 studies, which were primarily conducted in Confucian Asian and Anglo countries, with an increasing number of studies from other regions. Nearly all the studies used a quantitative design, reflecting a growing focus on how career-related components affect patient safety. The factors influencing stress were categorized into sociodemographic factors, the work environment, and personal resources, with sociodemographic factors showing variability across countries. The outcomes were categorized into health status, capability, affective and behavioral responses to work, and organizational performance, which generally yielded consistent results. These findings underscore the significant impact of stress on patient safety, highlighting the need for targeted interventions to mitigate stress and enhance patient safety culture and care outcomes [51].
Implications for nurse managers and nursing management
Our findings provide critical insights for nurse managers seeking to improve patient safety culture and mitigate job stress. The identified themes highlight the need for targeted interventions. Nurse managers should prioritize strategies to enhance teamwork through regular interprofessional training and structured communication protocols. They must advocate for adequate staffing levels and resource allocation to reduce workload-related stress. Implementing non-punitive error reporting systems and fostering open communication channels are also essential. Furthermore, nurse managers play a crucial role in providing supportive leadership, including conflict resolution and emotional support for their staff. By focusing on these areas, nurse managers can create a more resilient and safe work environment, ultimately improving patient outcomes.
Conclusion
Our research underscores the significant impact of job stress on PSC among hospital nurses in Palestine. Addressing factors such as teamwork, workload, staffing, communication, and support systems is essential for mitigating job stress and enhancing PSC. Healthcare institutions can promote a safer and more resilient healthcare environment by implementing targeted strategies and policies, ultimately improving patient outcomes and nurse satisfaction.
Our research identified six key themes: factors affecting PSC and management support, the reporting process, communication openness, job stress-related factors, effects of job stress, and coping mechanisms for job stress.
This study reveals a clear and vital link between job stress among Palestinian nurses and their perception of PSC. Stress-related factors impact how nurses respond to errors, communicate openly, report safety events, and experience support from hospital management. Job stress can hinder effective communication, lead to error concealment, and discourage safety reporting. The findings emphasize the need for continuous support, resource allocation, and a supportive culture to ensure high standards of patient care and nurse well-being.
Hospitals can create a safer, more patient-centered environment for healthcare professionals and patients by addressing job stress and bolstering support structures. Implementing these changes is crucial for fostering a culture that prioritizes patient safety and supports the well-being of nurses, thereby enhancing overall healthcare outcomes. Nurse managers should utilize these findings to implement specific, evidence-based interventions focused on improving nurse support, reducing job stress, and strengthening patient safety culture. These interventions will lead to tangible improvements in patient safety and clinical outcomes.
Recommendations
The study findings encourage these recommendations:
1.
Regulations should be implemented to address staffing levels, workload management, and support systems.
2.
A supportive environment that encourages error reporting and continuous improvement should be created.
3.
Foster a culture of teamwork, open communication, and non-punitive error reporting.
4.
Ensuring that leadership actively supports practices that enhance PSC.
5.
Develop training programs for leaders to create a supportive and just culture.
6.
Develop resilience training and stress management programs for nurses.
7.
Design interventions considering the unique sociocultural context of Palestine.
8.
Support systems for managing the emotional and physical demands of nursing should be provided.
Strengths and limitations
Phenomenological research, while a powerful qualitative approach for exploring individuals’ lived experiences and perceptions, has its limitations. One of the primary constraints is subjectivity; since phenomenology relies on interpreting participants’ experiences, it may be challenging to eliminate the researcher’s biases. Additionally, the sample size in phenomenological studies is typically small, which can limit the generalizability of findings to broader populations. Therefore, further quantitative and qualitative studies with larger samples are recommended.
Acknowledgements
This study is part of the author’s dissertation in nursing. We want to thank all the participants for their collaboration. The author is grateful to his supervisors for their guidance and support throughout the study. Special thanks to Dr. Lubna Harazneh for her guidance.
Declarations
Ethics approval and consent to participate
This study was carried out following the Helsinki Declaration, and approval was obtained from the Arab American University (AAUP) Institutional Review Board (IRB) under code 2023/A/114/N. All participants received an informed consent form that confirmed data privacy. All the data was kept confidential and used specifically for research. The participants were provided with an information sheet addressing potential queries. They were informed of the study’s purpose and their right to withdraw at any time. Additionally, no compensation was given to the participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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