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博碩士論文 etd-0619122-150245 詳細資訊
Title page for etd-0619122-150245
The Relationship between Safety Attitude, Job Satisfaction and Turnover Rate - A Multilevel Analysis
Year, semester
Number of pages
Jeng, Shaw-Yeu
Advisory Committee
林妍如, 許弘毅, 羅英瑛, 張宏泰
Lin, Yen-Ju; Shi, Hon-Yi; Lo, Ying-Ying; Chang, Hong-Tai
Date of Exam
Date of Submission
Safety Attitude Questionnaire, patient safety, organizational safety culture, job satisfaction, turnover rate, multilevel
本論文已被瀏覽 153 次,被下載 212
The thesis/dissertation has been browsed 153 times, has been downloaded 212 times.
「安全態度問卷(Safety Attitude Questionnaire, SAQ)」為我國醫療機構普遍使用之調查工具,目的在於了解各級醫療機構臨床人員對安全態度的認知,是我國針對醫療專業人員少數的大型調查之一;確保大規模調查的品質與內涵,對我國整體醫療產業管理與確保病人安全,相當重要。
Safety Attitude Questionnaire (SAQ) is the most popular scale for hospitals to measure safety attitude and climate in Taiwan. Organizations with good culture in patient safety are highly related to sound interaction among all members. Therefore, the purpose of this study is to examine the factors associated with employees’ job satisfaction and turnover rate, particularly the climate of patient safety.
This research used data of patient safety attitude survey collected by one medical center in southern Taiwan from 2014 to 2017. Study samples included physicians, nurses and administrative staff in the survey hospital. Turnover rates of different units were provided by department of human resource. The statistical analyses include describe statistics, correlation, factor analysis, CFA, multilevel model and latent growth curve model.
Results indicated that teamwork climate, perceptions of management and working conditions were correlated to job satisfaction positively with multilevel analysis. Stress recognition and work-life balance were correlated to job satisfaction positively. Emotional exhaustion mediated the relationship between multilevel correlation between perceptions of management and job satisfaction as well as the correlation between stress recognition and work-life balance to job satisfaction.
By ensuring the quality of the survey tools, this research deeply explored the relationship of dimensions and the connotations of the survey data with theoretical deductions.
目次 Table of Contents
論文審定書 i
致謝 ii
中文摘要 iii
英文摘要 iv
目錄 vi
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題 3
第二章 文獻探討及假設 5
第一節 病人安全文化與安全態度問卷 5
第二節 資源保存理論 8
第三節 安全態度、工作滿意度與離職率 9
第四節 安全態度、情緒耗竭與工作滿意度 15
第五節 不同年度的安全態度與工作滿意度及離職率變化 17
第六節 小結 17
第三章 研究方法 20
第一節 研究對象與資料來源 20
第二節 研究變數之操作型定義 21
第三節 統計與資料分析 25
第四章 研究結果 62
第一節 描述性統計 62
第二節 相關係數分析 69
第三節 階層線性模式分析 73
第四節 潛在成長曲線模型分析 93
第五節 研究假設驗證結果 97
第五章 討論 98
第一節 病人安全文化調查的信度與效度 98
第二節 安全態度調查的單位層次構面與個人層次構面與工作滿意度之關係 100
第三節 安全態度調查的單位層次構面與單位離職率之關係 102
第四節 安全態度調查的單位層次構面與個人層次構面與工作滿意度之中介效果 103
第五節 病人安全文化態度調查、單位離職率與成長效果 105
第六節 研究貢獻及管理內涵 106
第七節 研究限制及對未來研究之建議 107
第八節 結論 109
附錄SAQ「病人安全文化調查」於國際期刊發表之研究 111
參考文獻 136
參考文獻 References
Abdi, Z., Delgoshaei, B., Ravaghi, H., Abbasi, M., & Heyrani, A. (2015). The culture of patient safety in an Iranian intensive care unit. Journal of Nursing Management, 23(3), 333-345.
Alameddine, M., Saleh, S., & Natafgi, N. (2015). Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey. Human Resources for Health, 13, 37-50.
An, J. Y., Cha, S., Moon, H., Ruggiero, J. S. & Jang, H. (2016). Factors affecting job satisfaction of immigrant Korean nurses. Journal of Transcultural Nursing, 27(2), 126-135.
An, M., Colarelli, S. M., O'Brien, K., & Boyajian, M. E. (2016). Why we need more nature at work: Effects of natural elements and sunlight on employee mental health and work attitudes. PLoS ONE, 11(5): e0155614.
Anderson, S. E., Coffey, B. S., & Byerly, R. T. (2002). Formal organizational initiatives and informal workplace practices: Links to work-family conflict and job-related outcomes. Journal of Management, 28(6), 787-810.
Aronsson, G., Theorell, T., Grape, T., Hammarström, A., Hogstedt, C., Marteinsdottir, I., Skoog, I., …Hall, C. (2017). A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health, 17(1), 264-276.
Baker, F. B., & Kim, S. (2017). The basics of item response theory using R. Springer International Publishing AG.
Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the art. Journal of Managerial Psychology, 22(3), 309-328.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness-of -fit in the analysis of covariance structures. Psychological Bulletin, 88, 588-606.
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588-606.
Blanch, A., & Aluja, A. (2012). Social support (family and supervisor), work-family conflict, and burnout: Sex differences. Human Relations, 65(7), 811-833.
Bleakley, A., Allard, J., & Hobbs, A. (2012). Towards culture change in the operating theatre: embedding a complex educational intervention to improve teamwork climate. Medical Teacher, 34(9), e635-640.
Bondevik, G. T., Hofoss, D., Hansen, E. H., & Deilkås, E. C. (2014). Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices. Scandinavian Journal of Primary Health Care, 32(3), 132-138.
Bondevik, G. T., Hofoss, D., Hansen, E. H., & Deilkås, E. C. (2014). The safety attitudes questionnaire - ambulatory version: Psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Services Research, 14, 139-148.
Bondevik, G. T., Hofoss, D., Husebø, B. S., & Deilkås, E. C. T. (2017). Patient safety culture in Norwegian nursing homes. BMC Health Services Research, 17(1), 424-433.
Bratt, M. M., Baernholdt, M., & Pruszynski, J. (2014). Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme. Journal of Nursing Management, 22(6), 779-791.
Bredesen, I. M., Bjøro, K., Gunningberg, L., & Hofoss, D. (2015). Patient and organizational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis. BMJ Open, 5(8), e007584.
Breevaart, K., Bakker, A., Hetland, J., Demerouti, E., Olsen, O. K., & Espevik, R. (2014), Daily transactional and transformational leadership and daily employee engagement. Journal of Occupational and Organizational Psychology, 87, 138-157.
Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear models: Applications and data analysis methods. Sage Publications, Inc.
Buljac-Samardzic, M., van Wijngaarden, J. D., Dekker-van Doorn, C. M. (2016). Safety culture in long-term care: A cross-sectional analysis of the safety attitudes questionnaire in nursing and residential homes in the Netherlands. BMJ Quality & Safety, 25(6), 424-431.
Cai, L., & Monroe, S. (2014). A new statistic for evaluating item response theory models for ordinal data (CRESST Report 839). Los Angeles: University of California, National Center for Research on Evaluation, Standards, and Student Testing (CRESST).
Cain, C. L., Taborda-Whitt, C., Frazer, M., Schellinger, S, White, K. M., Kaasovic, J., Nelson, B., & Chant, A. (2017). A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team. Journal of Interprofessional Care, 31(6), 714-724.
Chalmers, R. P. (2012). MIRT: A multidimensional item response theory package for the R environment. Journal of Statistical Software, 48(6), 1-29.
Chamberlain, S. A., Hoben, M., Squires, J. E., & Estabrooks, C. A. (2016). Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Services Research, 16(1), 577-585.
Collar, R. M., Shuman, A. G., Feiner, S., McGonegal, A. K., Heidel, N., Duck, M., McLean, S. A., Billi, J. E., Healy, D. W., & Bradford, C. R. (2012). Lean management in academic surgery. American College of Surgeons, 214(6), 928-936.
Creswick, N., Westbrook, J. I., & Braithwaite, J. (2009). Understanding communication networks in the emergency department. BMC Health Services Research, 9, 247.
Cui, Y., Xi, X., Zhang, J., Feng, J., Deng, X., Li, A., & Zhou, J. (2017). The safety attitudes questionnaire in Chinese: psychometric properties and benchmarking data of the safety culture in Beijing hospitals. BMC Health Services Research, 17(1), 590-603.
Davenport, D. L., Henderson, W. G., Mosca, C. L., Khuri, S. F., & Mentzer Jr, R. M. (2007). Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. American College of Surgeons, 205, 778-784.
Deilkås, E. T., & Hofoss, D. (2008). Psychometric properties of the Norwegian version of the Safety Attitudes Questionnaire (SAQ), Generic version (Short Form 2006). BMC Health Services Research, 8, 191-200.
Deilkås, E., & Hofoss, D. (2010). Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture. BMC Health Services Research, 10, 85-89.
Delp, L., Wallace, S. P., Brown, J. G., & Muntaner, C. (2010). Job stress and job satisfaction: home care workers in a consumer-directed model of care. Health Services Research Journal, 45(4), 922-940.
DeMars, C. (2010). Item response theory. Oxford University Press.
Devriendt, E., Van den Heede, K., Coussement, J., Dejaeger, E., Surmont, K., Heylen, D., Schwendimann, R., Sexton, B., Wellens, N. I., Boonen, S., & Milisen, K. (2012). Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: An observational study. International Journal of Nursing Studies, 49(3), 327-37.
Dhaini, S. R., Denhaerynck, K., Bachnick, S., Schwendimann, R., Schubert, M., De Geest, S., & Simon, M. (2018). Work schedule flexibility is associated with emotional exhaustion among registered nurses in Swiss hospitals: A cross-sectional study. International Journal of Nursing Studies, 82, 99-105.
DiCuccio, M. H. (2015). The relationship between patient safety culture and patient outcomes: a systematic review. Journal of Patient Safety, 11(3), 135-42.
Dietz, A., Driskell, J. E., Sierra, M. J., Weaver, S. J., Driskell, T., & Salas, E. (2017). Teamwork under stress. in The Wiley Blackwell Handbook of the Psychology of Team Working and Collaborative Processes. Ed. E. Salas, R. Rico, J. Passmore. Malden, MA: Wiley-Blackwell, 2017. p. 297-316.
Dos Santos Alves, D. F., da Silva, D., & de Brito Guirardello, E. (2017). Nursing practice environment, job outcomes and safety climate: a structural equation modelling analysis. Journal of Nursing Management, 25(1), 46-55.
Edwards, M. C. (2009). An introduction to item response theory using the need for cognition scale. Social and Personality Psychology Compass, 3(4), 507-529. 2009.00194.x
Ein-Gal, Y., Pais, M., Gerber, A., Shabi, R., Karako, J., & Ben-Shalom, Y. (2014), A correlative study of conservation of resources among Tipat Halav nurses in Israel. Public Health Nursing, 31, 454-462.
Eltaybani, S., Noguchi-Watanabe, M., Igarashi, A., Saito, Y., & Yamamoto-Mitani, N. (2018). Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey. International Journal of Nursing Studies, 80, 118-127.
Etchegaray, J. M., Sexton, J. B., Helmreich, R. L., & Thomas, E. J. (2010). Job satisfaction ratings: Measurement equivalence across nurses and physicians. Western Journal of Nursing Research, 32(4), 530-539.
Eurfound. (2011, September 20). Working Conditions. Retrieved May 5, 2022, from
Evans, R. W., & Ghosh, K. (2015). A survey of headache medicine specialists on career satisfaction and burnout. The Journal of Head & Face Pain, 55(10), 1448-1157.
Everson, J., Funk, R. J., Kaufman, S. R., Owen-Smith, J., Nallamothu, B. K., Pagani, F. D., & Hollingsworth, J. M. (2017). Repeated, close physician coronary artery bypass grafting teams associated with greater teamwork, Health Services Research.
Fan, C. J., Pawlik, T. M., Daniels, T., Vernon, N., Banks, K., Westby, P., Wick, E. C., Sexton, J. B., & Makary, M. A. (2016). Association of safety culture with surgical site infection outcomes. Journal of the American College of Surgeons, 222(2), 122-128.
Fan, X., Thompson, B., & Wang, L. (1999). Effects of sample size, estimation methods, and model specification on structural equation modeling fit indexes. Structural Equation Modeling, 6(1), 56-83.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39-50.
France, D. J., Greevy, R. A. Jr., Liu, X., Burgess, H., Dittus, R. S., Weinger, M. B., Speroff, T. (2010). Measuring and comparing safety climate in intensive care units. Medical Care, 48(3):279-84.
Frankel, A., Grillo, S. P., Pittman, M., Thomas, E. J., Horowitz, L., Page, M., & Sexton, B. (2007). Revealing and resolving patient safety defects: The impact of Leadership WalkRounds on frontline caregiver assessments of patient safety. Health Services Research Journal, 43(6), 2050-2066.
Freedy, J. R., Hobfoll, S. E. (1994). Stress inoculation for reduction of burnout: A conservation of resources approach, Anxiety, Stress & Coping, 6(4), 311-325
Freedy, J. R., Hobfoll, S. E., & Ribbe, D. P. (1994). Life events, war and adjustment: Lessons for the middle east. Anxiety, Stress & Coping, 7(3), 191-203.
Fukui, S., Wu, W., & Salyers, M. P. (2019). Mediational paths from supervisor support to turnover intention and actual turnover among community mental health providers. Psychiatric Rehabilitation Journal, 42(4), 350-357.
Gallego, B., Westbrook, M. T., Dunn, A. G., & Braithwaite, J. (2012). Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. International Journal for Quality in Health Care, 24(4), 311-320.
Galletta, M., Portoghese, I., Penna, M.P., Battistelli, A. & Saiani, L. (2011), Turnover intention among Italian nurses: The moderating roles of supervisor support and organizational support. Nursing & Health Sciences, 13, 184-191.
Gandhi, T. K., Weingart, S.N., Borus, J., Seger, A.C., Peterson, J., Burdick E, Seger, D. L., Shu, K., Federico, F., Leape, L. L., & Bates, D. W. (2003). Adverse drug events in ambulatory care. The New England Journal of Medicine, 348, 1556-1564.
Garrouste-Orgeas, M., Perrin, M., Soufir, L., Vesin, A., Blot, F., Maxime, V., Beuret, P., …Timsit, J. F. (2015). The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture. Intensive Care Medicine: Home, 41(2), 273-284.
Gim, G. C. W., Desa, N. M., & Ramayah, T. (2015). Competitive psychological climate and turnover intention with the mediating role of affective commitment, Procedia Social and Behavioral Sciences, 172, 658-665.
Göras, C., Wallentin, F. Y., Nilsson, U. N., & Ehrenberg, A. (2013). Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version). BMC Health Services Research, 13, 104-110.
Graen, G. B., & Uhl-Bien, M. (1995). Relationship-based approach to leadership: Development of leader-member exchange (LMX) theory of leadership over 25 years: Applying a multi-level multi-domain perspective. The Leadership Quarterly, 6(2), 219-247.
Grandey, A., Foo, S. C., Growth, M.,& Goodwin, R. E. (2012). Free to be you and me: A climate of authenticity alleviates burnout from emotional labor. Journal of Occupational Health Psychology, 17(1), 1-14.
Greenglass, E. R., Burke, R. J. & Moore, K. A. (2003). Reactions to increased workload: effects on professional efficacy of nurses. Applied Psychology, 52, 580-597.
Greenglass, E. R., Burke, R. J., & Fiksenbaum, L. (2001), Workload and burnout in nurses. J. Community. Journal of Applied Social Psychology, 11, 211-215.
Haerkens, M. H., van Leeuwen, W., Sexton, J. B., Pickkers, P., van der Hoeven, J. G. (2016). Validation of the Dutch language version of the Safety Attitudes Questionnaire (SAQ-NL). BMC Health Services Research, 16(a), 385-392.
Haines, A., Perkins, E., Evans, E. A., & McCabe, R. (2018). Multidisciplinary team functioning and decision making within forensic mental health. Mental Health Review Journal, 23(3), 185-196.
Hair, J. F., Black, W. C., Babin, B. J. & Anderson, R. E. (2010) Multivariate Data Analysis. 7th Edition, Pearson, New York.
Halbesleben, J. B., Paustian-Underdal, S. C., & Westman, M. (2014). Getting to the "COR": Understanding the role of resources in conservation of resources theory. Journal of Management, 40(5), 1334-1364.
Hammons, T., Piland, N. F., Small, S. D., Hatlie, M. J., & Burstin, H. R. (2003). Ambulatory patient safety. What we know and need to know. Journal of Ambulatory Care Management, 26, 63-82.
Han, K, Trinkoff, A. M., Storr, C. L., Lerner, N., Johantgen, M., & Gartrell, K. (2014). Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis. International Journal of Nursing Studies, 51(8), 1135-1141.
Han, K., Trinkoff, A. M., & Gurses, A. P. (2015). Work-related factors, job satisfaction and intent to leave the current job among United States nurses. Journal of Clinical Nursing, 24(21-22), 3224-3232.
Havyer, R. D., Wingo, M. T., Comfere, N.I., Nelson, D. R., Halvorsen, A. J., McDonald, F. S., & Reed, D. A. (2013). Teamwork assessment in internal medicine: A systematic review of validity evidence and outcomes. Journal of General Internal Medicine, 29(6), 894-910.
Heim E. (1991). Job stressors and coping in health professions. Psychother Psychosom, 55(2-4), 90-9.
Hertzog, C., Lindenberger, U., Ghisletta, P., & von Oertzen, T. (2006). On the power of multivariate latent growth curve models to detect correlated change. Psychological Methods, 11(3), 244-252.
Hill, M. R., Goicochea, S., & Merlo, L. J. (2018). In their own words: stressors facing medical students in the millennial generation. Medical education online, 23(1), 1530558.
Hill, M. R., Roberts, M. J., Alderson, M. L., & Gale, T. C. (2015). Safety culture and the 5 steps to safer surgery: an intervention study. British Journal of Anaesthesia, 114(6), 958-962.
Hinde, T., Gale, T., Anderson, I., Roberts, M., & Sice, P. (2016). A study to assess the influence of interprofessional point of care simulation training on safety culture in the operating theatre environment of a university teaching hospital. Journal of Interprofessional Care, 30(2), 251-253.
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513-524.
Hobfoll, S. E. (2001). The influence of culture, community, and the nested-self in the stress process: Advancing Conservation of Resources theory. Applied Psychology: An International Review, 50(3), 337-370.
Hobfoll, S. E. (2011). Conservation of resource caravans and engaged settings. Journal of Occupational and Organizational Psychology, 84, 116-22.
Hobfoll, S. E., & Lilly, R. S. (1993). Resource conservation as a strategy for community psychology. Journal of Community Psychology, 21(2), 128-148.
Hobfoll, S. E., Halbesleben, J., Neveu, J.-P., & Westman, M. (2018). Conservation of resources in the organizational context: the reality of resources and their consequences. Annual Review of Organizational Psychology and Organizational Behavior, 5(1), 103-128.
Hobfoll, S., Freedy, J., & Geller, P. (1990). Conservation of social resources: Social support resource theory. Journal of Social and Personal Relationships, 7, 465-478.
Hofmann, D. A. (1997). An overview of the logic and rationale of hierarchical linear models. Journal of Management, 23(6), 723-744.
Hofmann, D. A., Gavin, M. B., ( 1998). Centering decisions in hierarchical linear models: implications for research in organizations. Journal of Management, 124(5), 623-641.
Hofoss, D., & Deilkås, E. (2008). Roadmap for patient safety research: Approaches and roadforks. Scandinavian Journal of Public Health, 36(8):812-817.
Hox, J., & Maas, C. J. M. (2005). Sufficient sample sizes for multilevel modeling. Methodology: European Journal of Research Methods for The Behavioral and Social Sciences, 1, 86-92.
Hu, Q., Schaufeli, W. B., Taris, T. W., Shimazu, A., & Dollard, M. F. (2019). Resource Crafting: Is It Really 'Resource' Crafting-Or Just Crafting?. Frontiers in psychology, 10, 614.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.
Huang, D. T., Clermont, G., Kong, L., Weissfeld, L. A., Sexton, J. B., Rowan, K. M., & Angus, D. C. (2010). Intensive care unit safety culture and outcomes: a US multicenter study. International Journal for Quality in Health Care, 22(3), 151-161.
Huang, D. T., Clermont, G., Sexton, J. B., Karlo, C. A., Miller, R. G., Weissfeld, L. A., Rowan, K. M., & Angus, D. C. (2007). Perceptions of safety culture vary across the intensive care units of a single institution. Critical Care Medicine, 35(1):165-76.
Hughes, R. G., & Clancy, C. M. (2005). Working conditions that support patient safety. Journal of Nursing Care Quality, 20 (4), 289-292.
Hunt, D. (2014). Does value congruence between nurses and supervisors effect job satisfaction and turnover? Journal of Nursing Management, 22(5), 572-582.
Itzhaki, M., Ea, E., Ehrenfeld, M., & Fitzpatrick, J. J. (2013). Job satisfaction among immigrant nurses in Israel and the United States of America. International Nursing Review, 60(1), 122-128.
James, L. (1982). Aggregation bias in estimates of perceptual agreement. Journal of Applied Psychology, 67, 219-229.
Jarosova, D., Gurkova, E., Palese, A., Godeas, G., Ziakova, K., Song, M. S., Lee, J., …Nedvedova, D. (2016). Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey. Journal of Midwifery & Women's Health, 62(2), 180-189.
Je, S. M., Kim, H. J., You, J. S., Chung, S. P., Cho, J., Lee, J. H., Lee, H. S., & Chung, H. S. (2014). Assessing safety attitudes among healthcare providers after a hospital-wide high-risk patient care program. Yonsei Medical Journal, 55(2), 523-529.
Jeong, H. J., Lee, W. C., Liao, H. H., Chu, F. Y., Chen, T. J., & Wang, P. C. (2019). The hospital patient safety culture survey: Reform of analysis and visualization methods. International Journal of Environmental Research and Public Health, 16(19), 3624.
Jeong, H. J., Liao, H. H., Han, S. H., & Lee, W. C (2020). An application of item response theory to scoring patient safety culture survey data. International Journal of Environmental Research and Public Health, 17(3), 854.
Kalisch, B. J., Lee, H, & Rochman, M. (2010). Nursing staff teamwork and job satisfaction. Journal of Nursing Management, 18(8), 938-947.
Kawano, T., Taniwaki, M., Ogata, K., Sakamoto, M., & Yokoyama, M. (2014). Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan. Journal of Anesthesia, 28(3), 467-470.
Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B (2016). Work related stress, burnout, job satisfaction and general health of nurses: a follow-up study. International Journal of Nursing Practice, 22(6), 538-545.
Kim, S. H., & Weng, S. J. (2018). Incorporating work experience of medical staff into patient safety climate management: A multi-group analysis. BMC Health Services Research, 18(1), 919.
Klemenc-Ketis, Z., Maletic, M., Stropnik, V., Deilkås, E. T., Hofoss, D., & Bondevik, G. T. (2017). The safety attitudes questionnaire - ambulatory version: psychometric properties of the Slovenian version for the out-of-hours primary care setting. BMC Health Services Research, 17(1), 36-42.
Kowalski, C., Ommen, O., Driller, E., Ernstmann, N., Wirtz, M.A., Köhler, T., & Pfaff, H. (2010). Burnout in nurses - the relationship between social capital in hospitals and emotional exhaustion. Journal of Clinical Nursing, 19, 1654-1663.
Kozlowski, S. W. J., & Klein, K. J. (2000). A multilevel approach to theory and research in organizations: Contextual, temporal, and emergent processes. In K. J. Klein, K. J.,& Kozlowski, S. W. J.(Eds.), (2013). Multilevel theory, research, and methods in organizations: Foundations, extensions, and new directions (pp. 3-90). Jossey-Bass.
Kristensen, S., Sabroe, S., Bartels, P., Mainz, J., & Christensen, K. B. (2015). Adaption and validation of the Safety Attitudes Questionnaire for the Danish hospital setting. Clinical Epidemiology, 7, 149-160.
Krull, J. L., & MacKinnon, D. P. (1999). Multilevel mediation modeling in group-based intervention studies. Evaluation Review, 23(4), 418-444.
Krull, J. L., & MacKinnon, D. P. (2001). Multilevel modeling of individual and group level mediated effects. Multivariate Behavioral Research, 36(2), 249-277.
Lee, W. C., Han, S. H., & Jeong H. J. (2020). Ensuring Taiwan patient safety culture survey is free from differential item functioning. The International Journal of Health Planning and Management, 35(2), 614-624.
Lee, W. C., Wung, H. Y., Liao, H. H., Lo, C. M., Chang, F. L., Wang, P. C., Fan, A., … Hou, S. M. (2010). Hospital safety culture in Taiwan: A nationwide survey using Chinese version Safety Attitude Questionnaire. BMC Health Services Research, 10, 234-241
Lee, W., Jeong, H., Liao, H., Wen, C., & Wang, P. (2018). Item response theory-based validation of Taiwanese patient safety culture measurement instrument. Biometrics & Biostatistics International Journal, 7(4), 272-277.
Lee, Y. C., Huang, C. H., Weng, S. J., Hsieh. W. L., & Wu, H. H. (2016). Analyzing emotional exhaustion from viewpoints of physicians and nurses—a case of a regional teaching hospital. TEM Journal, 5(2), 231-235.
Lee, Y. C., Huang, S. C., Huang, C. H., & Wu, H. H. (2016). A new approach to identify high burnout medical staffs by kernel k-means cluster analysis in a regional teaching hospital in Taiwan. Healthcare in the National Health Insurance System in Taiwan, 53, 1-6.
Lee, Y. C., Wu, H. H., Hsieh, W. L., Weng, S. J., Hsieh, L. P., & Huang, C. H. (2015). Applying importance-performance analysis to patient safety culture. International Journal of Health Care Quality Assurance, 28(8), 826-840.
Li, Y., Zhao, X., Zhang, X., Zhang, C., Ma, H., Jiao, M., Li, X., …Yin, M. (2017). Validation study of the safety attitudes questionnaire (SAQ) in public hospitals of Heilongjiang province, China. PLoS One, 12(6), e0179486.
Li, Y., Zhao, Y., Hao, Y., Jiao, M., Ma, H., Teng, B., Yang, K., Sun, T., Wu, Q., & Qiao, H. (2018). Perceptions of patient safety culture among healthcare employees in tertiary hospitals of Heilongjiang province in northern China: A cross-sectional study. International Journal for Quality in Health Care, 30(8), 618-623.
Liang, H. Y., Tang, F. I., Wang, T. F., Lin, K. C., & Yu, Shu. (2016). Nurse characteristics, leadership, safety climate, emotional labour and intention to stay for nurses: a structural equation modelling approach. Journal of Advanced Nursing, 72(12), 3068-3080.
MacPhee. M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences; 7(1), 7.
Magill, S. T., Wang, D. D., Rutledge, W. C., Lau, D., Berger, M. S., Sankaran, S., Lau, C. Y., & Imershein, S. G. (2017). Changing operating room culture: implementation of a postoperative debrief and improved safety culture. World Neurosurgery, 107, 597-603.
Makary, M. A., Sexton, J. B., Freischlag, J. A., Holzmueller, C. G., Millman, E. A., Rowen, L., & Pronovost, P. J. (2006). Operating room teamwork among physicians and nurses: Teamwork in the eye of the beholder. American College of Surgeons, 202, 746-752.
Marsh, H. W., Balla, J. R., & Hau, K. T. (1996). An evaluation of incremental fit indexes: a clarification of mathematical and empirical properties. In G. A. Marcoulides, & R. E. Schumacker (Eds.), Advanced Structural Equation Modeling Techniques (pp. 315-353). Mahwah, NJ: Lawrence Erlbaum.
Martinez, W., Lehmann, L. S., Thomas, E. J., Etchegaray, J. M., Shelburne, J. T., Hickson, G. B., Brady, D. W., Schleyer, A. M., Best, J. A., May, N. B., & Bell, S. K. (2017). Speaking up about traditional and professionalism-related patient safety threats: A national survey of interns and residents. BMJ Quality & Safety, 26(11), 869-880.
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behaviour, 2, 99-113
McDonald, R. P., & Ho, M.-H. R. (2002). Principles and practice in reporting structural equation analyses. Psychological Methods, 7(1), 64-82.
McDonald, S., & Ahern, K. (2002). Physical and emotional effects of whistleblowing. Journal of Psychosocial Nursing and Mental Health Services, 40(1), 14-27.
McGuire, M. J., Noronha, G., Samal, L., Yeh, H. C., Crocetti, S., & Kravet, S. (2012). Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System. Journal of General Internal Medicine, 28(2), 184-192.
McKerrow, I., Carney, P. A., Caretta-Weyer, H., Furnari, M., & Miller Juve, A. (2020). Trends in medical students' stress, physical, and emotional health throughout training. Medical Education Online, 25(1), 1709278.
Meeks, D. W., Lally, K. P., Carrick, M. M., Lew, D. F., Thomas, E. J., Peter D. Doyle, P. D., & Kao, L. S. (2011). Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? The American Journal of Surgery, 201, 76-83.
Meichenbaum, D. H., & Deffenbacher, J. L. (1988). Stress inoculation training. The Counseling Psychologist, 16(1):69-90.
Meredith, W., & Tisak, J. (1990). Latent curve analysis. Psychometrika, 55, 107-122.
Modak, I., Sexton, J. B., Lux, T. R., Helmreich, R. L., & Thomas, E. J. (2007). Measuring safety culture in the ambulatory setting: The Safety Attitudes Questionnaire-Ambulatory Version. Society of General Internal Medicine, 22, 1-5.
Nejati, A, Rodiek, S, Shepley, M. (2016). Does value congruence between nurses and supervisors effect job satisfaction and turnover? Journal of Nursing Management, 22(5), 572-582.
Nejati, A., Shepley, M., & Rodiek, S. ( 2016). A review of design and policy interventions to promote nurses’ restorative breaks in health care workplaces. Workplace Health & Safety, 64(2), 70-77.
Nguyen, G., Gambashidze, N., Ilyas, S. A., & Pascu, D. (2015). Validation of the safety attitudes questionnaire (short form 2006) in Italian in hospitals in the northeast of Italy. BMC Health Services Research, 15, 284-291.
Nichols, H., Swanberg, J.,& Bright, C. (2016). How does supervisor support influence turnover intent among frontline hospital workers? The mediating role of affective commitment. The Health Care Manager, 35. 266-279.
Nilsson, U., Göras, C., Wallentin, F., & Ehrenberg, A., & Unbeck, M. (2018). The Swedish Safety Attitudes Questionnaire- Operating Room Version: Psychometric properties in the surgical team. Journal of PeriAnesthesia Nursing, 33.
Nitzsche, A., Neumann, M., Groß, S. E., Ansmann, L., Pfaff, H., Baumann, W., Wirtz, M., …Ernstmann, N. (2017). Recovery opportunities, work-home conflict, and emotional exhaustion among hematologists and oncologists in private practice. Psychology, Health & Medicine, 22(4), 462-473.
Olsson, C., Forsberg, A., & Bjerså, K. (2016). Safety climate and readiness for implementation of evidence and person centered practice - A national study of registered nurses in general surgical care at Swedish university hospitals. BMC Nursing, 15(1), 54-65.
Padiyara, R. S., & Komperda, K. E. (2010). Effect of postgraduate training on job and career satisfaction among health-system pharmacists. American Journal of Health-System Pharmacy, 67(13), 1093-100.
Paine, L. A., Rosenstein, B. J., Sexton, J. B., Kent, P., Holzmueller, C. G., & Pronovost, P. J. (2011). Republished paper: Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study. Postgraduate Medical Journal, 87, 428-435.
Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. American Psychological Association; Oxford University Press.
Poncet, M. C., Toullic, P., Papazian, L., Kentish-Barnes, N., Timsit, J. F., Pochard, F., …Azoulay E. (2007). Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine, 175(7), 698-704.
Preacher, K. J., Wichman, A. L., MacCallum, R. C., & Briggs, N. E. (2008). Latent growth curve modeling. SAGE Publications, Inc.
Preacher, K. J., Zyphur, M. J., & Zhang, Z. A. (2010). General multilevel SEM framework for assessing multilevel mediation. Psychol Methods, 15(3), 209-233.
Purpora, C., & Blegen, M. A. (2015). Job satisfaction and horizontal violence in hospital staff registered nurses: the mediating role of peer relationships. Journal of Clinical Nursing, 24(15-16), 2286-2294.
Putnam, L. R., Levy, S. M., Kellagher, C. M., Etchegaray, J. M., Thomas, E. J., Kao, L. S., Lally, K. P., & Tsao, K. (2015). Surgical resident education in patient safety: where can we improve? Journal of Surgical Research, 199(2), 308-313.
Quiñones, M., Van den Broeck, A., & De Witte, H. (2013). Do job resources affect work engagement via psychological empowerment? A mediation analysis. Journal of Work and Organizational Psychology, 29. 127-134.
Raftopoulos, V., Savva, N., & Papadopoulou, M. (2011). Safety culture in the maternity units: A census survey using the Safety Attitudes Questionnaire. BMC Health Services Research, 11, 238-247.
Ragab, E. A., Dafallah, M. A., & Salih, M. H. (2021). Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation. Middle East Current Psychiatry , 28, 75.
Rathert, C., Williams, E., Lawrence, E. R., & Halbesleben, J. R. (2012). Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework. International Journal of Nursing Studies, 49(8), 969-977.
Reise, S. P. (2015). Item response theory. In R. L. Cautlin & S. O. Lilenfeld (Eds.), The Encyclopedia of Clinical Psychology. (pp. 1557-1566). John Wiley & Sons, Inc.
Rizvi, R., Raymer, L., Mark Kunik, M., & Fisher, J. (2012). Facets of Career Satisfaction for Women Physicians in the United States: A Systematic Review. Women's Health, 52(4), 403-421.
Rodgers, J. L.,& Nicewander, W. A. (1988). Thirteen ways to look at the correlation coefficient. The American Statistician, 42(1), 59-66.
Ross, J., Wolf, D., & Reece, K. (2014). Highly reliable procedural teams: the journey to spread the universal protocol in diagnostic imaging. The Permanente Journal, 18(1), 33-37.
Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. Journal of General Internal Medicine, 32(4), 475-482.
Santana, H. T., Rodrigues, M. C., do Socorro Nantua Evangelista, M. (2016). Surgical teams' attitudes and opinions towards the safety of surgical procedures in public hospitals in the Brazilian Federal District. BMC Research Notes, 9, 276-284.
Saraiva, D., & Almeida, A. (2015). Climate Measurement of Patient Safety in the Health Service-Portuguese Version of the Safety Attitudes Questionnaire Short Form 2006. Value in Health, 18(7), A853-854.
Schwendimann, R., Zimmermann, N., Küng, K., Ausserhofer, D., & Sexton B. (2013). Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study. BMJ Quality & Safety, 22(1), 32-41.
Selig, J. P., & Preacher, K. J. (2008). Monte Carlo method for assessing mediation: An interactive tool for creating confidence intervals for indirect effects [Computer software]. Available from
Sexton, J. B., Adair, K. C., Leonard, M. W., Frankel, T. C., Proulx, J., Watson, S. R., Magnus, B., …Frankel, A. S. (2017). Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout. BMJ Quality & Safety, 0, 1-10.
Sexton, J. B., Helmreich1, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., Roberts, P. R., & Thomas, E. J. (2006). The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services Research, 6(44).
Sexton, J. B., Holzmueller, C. G., Pronovost, P. J., Thomas, E. J., McFerran, S., Nunes, J., Thompson, D. A., …Fox, H. E. (2006). Variation in caregiver perceptions of teamwork climate in labor and delivery units. Journal of Perinatology,26, 463-470.
Sexton, J., Schwartz, S., Chadwick, W., Rehder, K., Bae, J., Bokovoy, J., & Doram, K., Sotile, W., Adair, K., & Profit, J. (2016). The associations between work-life balance behaviours, teamwork climate and safety climate: Cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ quality & safety. 26(8), 632-640.
Shi, D., DiStefano, C., Zheng, X., Liu, R., & Jiang, Z. (2021). Fitting latent growth models with small sample sizes and non-normal missing data. International journal of behavioral development, 45(2), 179-192.
Shie, H. G., Lee, W. C., Hsiao, H. F., Lin, H. L., Yang, L. L., & Jung, F. (2011). Patient safety attitudes among respiratory therapists in Taiwan. Respiratory Care, 56(12), 1924-1929.
Shoushtarian, M., Barnett, M., McMahon, F., & Ferris, J. (2014). Impact of introducing practical obstetric multi-professional training (PROMPT) into maternity units in Victoria, Australia. International Journal of Obstetrics & Gynaecology, 121(13), 1710-1718.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422-445.
Siassakos, D., Draycott, T., Crofts, J., Hunt, L., Winter, C., & Fox, R. (2010). More to teamwork than knowledge, skill and attitude. An International Journal of Obstetrics and Gynaecology, 117, 1262-1269.
Smits, M., Keizer, E., Giesen, P., Deilkås, E. C. T., Hofoss, D., & Bondevik, G. T. (2017). The psychometric properties of the ‘safety attitudes questionnaire’ in out-of-hours primary care services in the Netherlands. PLoS ONE 12(2): e0172390.
Soh, S. E., Barker, A., Morello, R., Dalton, M., & Brand, C. (2016). Measuring safety climate in acute hospitals: Rasch analysis of the safety attitudes questionnaire. BMC Health Services Research, 16, 497-507.
Sonoda, Y., Onozuka, D., Hagihara, A. (2018). Factors related to teamwork performance and stress of operating room nurses. Journal of Nursing Management, 26, 66- 73.
Sorra, J, & Nieva, V. F. (2003). Safety culture assessment: A tool for improving patient safety in healthcare organizations. Quality & Safety in Health Care 2003, 12(2), 17-23.
Speroff, T., Nwosu, S., Greevy, R., Weinger, M., Talbot, T., Wall, R., Deshpande, J., France, D., Ely, E., Burgess, H., Englebright, J., Williams, M., & Dittus, R. (2010). Organisational culture: Variation across hospitals and connection to patient safety climate. Quality & safety in health care, 19, 592-596.
Taylor, J. A., & Pandian, R. (2013). A dissonant scale: stress recognition in the SAQ. BMC Research Notes, 6, 302-307.
Taylor, J. A., Dominici, F., Agnew, J., Gerwin, D., Morlock, L., Miller, M. R. (2012). Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ Quality & Safety, 21(2), 101-111.
Tesluk, P. E., & Jacobs, R. R. (1998). Toward an integrated model of work experience. Personnel Psychology, 51(2), 321-355.
Tucker, L.R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1-10.
van der Velden, P. G., Pecoraro, M., Houwerzijl, M. S., & van der Meulen, E. Mental (2019). Health problems among whistleblowers: a comparative study. Psychological Reports, 122(2), 632-644.
Vincent, C. A., Taylor-Adams, S., Stanhope, N. (1998). Framework for analyzing risk and safety in clinical medicine. British Medical Journal, 316, 1154-1157.
Viotti, S., & Converso, D. (2016). Relationship between job demands and psychological outcomes among nurses: Does skill discretion matter? International Journal of Occupational Medicine and Environmental Health, 29(3), 439-460.
Voltmer, E., Köslich-Strumann, S., & Voltmer, J. B. (2021). Stress and behavior patterns throughout medical education - a six year longitudinal study. BMC Medical Education, 21, 454
Waddimba, A. C., Scribani, M., Krupa, N., May, J. J., & Jenkins, P. (2017). Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners. BMC Health Services Research, 16(1), 613-627.
Weaver, A. C., Callaghan, M., Cooper, A. L., Brandman, J., & O'Leary, K. J. (2015). Assessing interprofessional teamwork in inpatient medical oncology units. Journal of Oncology Practice, 11(1), 19-22.
Wells, J., Hobfoll, S., & Lavin, J. (1999). When it rains, it pours: the greater impact of resource loss compared to gain on psychological distress. Personality and Social Psychology Bulletin, 25, 1172-1182.
Weng, S. J., Kim, S. H., & Wu, C. L. (2017). Underlying influence of perception of management leadership on patient safety climate in healthcare organizations - A mediation analysis approach. International Journal for Quality in Health Care, 29(1), 111-116.
Wong, S. S., Wang, C. H., Cheng, C. H., Ong, E. T., & Huang, Y. L. (2017). Patient Safety Attitudes between intensive care units and general ward staff: A survey of a medical center in northern Taiwan. Fu-Jen Journal of Medicine, 15(3), 121-130.
Youssef, C. M., & Luthans, F. (2007). Positive organizational behavior in the workplace: The impact of hope, optimism, and resilience. Journal of Management, 33(5), 774-800.
Zaheer, S., Ginsburg, L., Wong, H.J. (2021). Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety - A mixed methods study. BMC Nursing, 20, 134.
Zenere, A., Zanolin, ME., Negri, R., Moretti, F., Grassi, M., & Tardivo, S. (2016). Assessing safety culture in NICU: psychometric properties of the Italian version of Safety Attitude Questionnaire and result implications. Journal of Evaluation in Clinical Practice, 22(2), 275-282.
Zimmermann, N., Küng, K., Sereika, S. M., Engberg, S., Sexton, B., & Schwendimann, R. (2013). Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - a validation study. BMC Health Services Research, 13, 347-357.
邱皓政(民106)。多層次模式與縱貫資料分析:Mplus 8 解析應用,台北市:五南。
陳怡甄、郭素娥、阮祺文(民106)。護理人員的病人安全文化對工作生活平衡之影響-復原力之調節效果,弘光學報,80,P13 - 26。
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