Journal of PeriAnesthesia Nursing xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of PeriAnesthesia Nursing

journal homepage: www.jopan.org

Research

Safety Climate and Organizational Communication Satisfaction Among

Korean Perianesthesia Care Unit Nurses
Jebog Yoo, PhD, RN a, Seung Eun Chung, PhD, RN b, Juyeon Oh, PhD, RN c, *
a
Department of Nursing, Gyeongnam National University of Science and Technology, JinJu, South Korea
b
Department of Nursing, Korea National University of Transportation, Jeungpyeong, South Korea
c
College of Nursing, Dankook University, Cheonan, South Korea

a b s t r a c t
Keywords: Purpose: This study investigated organizational communication satisfaction and safety climate among
communication perianesthesia care unit (PACU) nurses and factors affecting safety climate.
organization
Design: A cross-sectional study of 103 registered nurses currently working in PACUs in Korea.
patient safety
perianesthesia care unit
Methods: Organizational communication satisfaction was measured using the Communication Satis-
satisfaction faction Questionnaire, and safety climate was assessed using the Safety Attitudes Questionnaire-Korean
version 2. Additional questions covered the demographics of the respondents and the characteristics of
the hospital where they worked.
Findings: Factors affecting teamwork climate included communication climate and horizontal informal
communication. Safety climate was affected by media quality and organizational integration; job satis-
faction by working in secondary hospitals, communication climate, and media quality; perception of
management by working in public hospitals, media quality, and personal feedback; and working con-
ditions by working in public hospitals, media quality, and personal feedback.
Conclusions: The results show that Korean PACU nurses experience poorer safety climate compared with
other countries. One suggestion is to enhance nurses’ satisfaction using organizational communication
(eg, by developing effective communication media that satisfy users) and to promote communication at
an organizational level so that individual health care professionals are aware of their organizations’
vision and policies.
© 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.

Patient safety is a major global public health concern. Health
care errors and adverse events costs millions of lives each year and
have important financial consequences.1 In the United States,
medical error is the third most common cause of death after heart
disease and cancer, leading to more than 250,000 deaths annually.2
This situation is not different in Asian countries, including Korea.
Although there is no formal data on the incidence of adverse events
or medical errors in Korea,3 a previous study reported a 7.2% inci-
dence of adverse events, of which 61% were preventable.4 The
number of medical dispute consultation cases in 2018 in Korea was
65,176, a 10% increase over the previous 5 years. With the goals of
preventing health care errors and enhancing the quality of care, the
Conflicts of interest: none to report.
* Address correspondence to Juyeon Oh, College of Nursing, Dankook University,
119 Dandae-ro, Donnam-gu, Cheonan, 31116, South Korea.
E-mail address: ohjy@dankook.ac.kr (J. Oh).
Patient Safety Act was implemented in July 2016 in Korea, and
patient safety indicators and standards were also introduced.5 As
the role of a hospital’s safety climate has been established as a
major factor in this regard,1 this study examines organizational
communication satisfaction and safety climate among a key group
of nurses.
It is well known that hospitals with a more positive safety
climate (ie, the perception of the state of safety among individuals
at a point in time) have lower error rates and better patient out-
comes.1 Because the Institute of Medicine’s landmark report “To Err
is Human: Building a Safer Health System,”6 the paradigm has
shifted from blaming individuals for errors to identifying the
weaknesses in the system that lead to adverse events. Despite
relatively advanced medical technology and comparable safety
records, the Korean health care industry has lower levels of staffing
and less open communication than is the case in Western countries.
More importantly, in the Korean health care industry, there is a
lower level of understanding of human factors engineering or the

https://doi.org/10.1016/j.jopan.2020.04.009
1089-9472/© 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.

Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
2 Yoo et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx
systems approach to patient safety.7 For example, a secretive and
blaming culture is prevalent because of the highly competitive
environment in the Korean health care industry. Moreover, there is
a lack of open communication about errors in Korea (ie, less dis-
cussion and feedback) because of the influence of Confucianism,
whereby individuals believe that this kind of discussion may hu-
miliate their coworkers.7 The health system’s strong hierarchical
nature generates a culture where supervisors or those in senior
roles generally punish workers in lower positions who make mis-
takes; workers are thus reluctant to report errors or safety issues.
This dominant hierarchical culture can inhibit a positive safety
climate because of fear of negative outcomes and blame for
reporting safety-related concerns.8 Antonsen proposed that an
organizational safety culture is associated with interaction such as
communication, social relationships, and cooperation.9 Communi-
cation is extremely important in the health care context, where
diverse health professionals typically work within multidisci-
plinary teams. Nurses, in particular, must communicate with a va-
riety of different professions as part of their role. Specifically,
organizational communication is a key issue in safety climate, as it
produces and reproduces a safety culture system within a health
care organization.10
The perianesthesia care unit (PACU) in Korea is an especially
hazardous place with a high potential for major medical errors
related to surgery, anesthesia and recovery,11-13 including difficult
airway management, perioperative massive bleeding, and the
administration of medicines such as patient-controlled analgesia,
cardiovascular drugs, muscle relaxants, and analgesic drugs when
patients display unstable vital signs. Therefore, nurses working in
the PACU as frontline health care providers are faced with many
challenges in ensuring patient safety. Moreover, PACU nurses have
unique working conditions characterized by a complex and highly
technical environment and the provision of continuous patient care
immediately after surgery.14 Furthermore, these special settings
where multiple disciplines work together intensify the importance
of organizational communication.
Most previous studies have examined the safety climate on
general wards in hospitals, and few have focused on specialized
departments such as the PACU. Kaafarani et al15 reported that
nurses in operating theaters and PACU experience a similar or
slightly worse safety climate than other hospital work areas, but
this has not been investigated in the Korean health care industry.
Moreover, to establish an adequate safety climate within an orga-
nization, it is important to identify the factors that influence it.
Purpose
This study aimed to examine organizational communication
satisfaction and safety climate among Korean PACU nurses and to
analyze factors affecting safety climate.
Methods
Study Design
This was a cross-sectional survey study.
Sample and Data Collection
A sample size of 135 was calculated by G*Power 3.1.9.2 using the
following parameters for a F-test in linear multiple regression: ef-
fect size of 0.1, significance level of 0.05, statistical power of 80%, 11
variables as predictive factors, and a 10% drop-out rate. The inclu-
sion criteria for the study were (1) currently working in PACU as a
registered nurse and (2) having at least 3 months of working
Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
experience in this role. We excluded nurses (1) who were not
currently working in PACU and (2) who did not provide direct
nursing care (eg, managers). Participants were recruited through
convenience sampling at a conference of the Korean Association of
Perianesthesia Nurses on 11 May 2019. The Korean Association of
Perianesthesia Nurses is a nationwide organization for nurses
working in PACUs and organizes educational courses and confer-
ences. At the time of registration at the conference, we provided
135 nurses with the following: a cover letter including information
on the study purpose and the voluntary nature of participation and
assurances of both participant anonymity and data confidentiality;
an informed consent form; and a structured questionnaire. A total
of 112 nurses returned the completed questionnaire and signed the
informed consent form (response rate: 83.0%). After excluding
incomplete questionnaires, a total of 103 (response rate: 92.0%)
completed questionnaires were used in the analysis.
Measures
Organizational communication satisfaction was measured using
the Communication Satisfaction Questionnaire originally devel-
oped by Downs and Hazen.16 The Korean version used by Kim et al17
was employed in this study. This questionnaire consisted of 24
items with eight subdomains (three items each): communication
climate, relation with supervisor, media quality (nurses’ perceived
level of the effectiveness of the formats or channels used for hos-
pital communication), horizontal informal communication, orga-
nizational integration, personal feedback, general organizational
perspectives, and relation with subordinate. Each item is rated on a
5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree);
the subdomain score is the average of the scores of the subdomain
items, and higher scores indicate higher satisfaction with
communication. In this study, the “relation with subordinate”
subdomain items were excluded from the analysis because most of
the participants were staff nurses. Cronbach’s a was 0.89 in this
study, indicating excellent internal consistency.
Safety climate was assessed using the Safety Attitudes
Questionnaire-Korean version 2 (SAQ-K2), originally developed by
Sexton et al18 and translated and validated into Korean by Jeong
et al19 The SAQ-K2 contains 23 items with five subdomains:
teamwork climate (5 items), safety climate (5 items), job satisfac-
tion (5 items), perception of management (4 items), and working
conditions (4 items). Each item is rated on a 5-point Likert scale
from 1 (strongly disagree) to 5 (strongly agree), and the subdomain
score is the average of the scores of the subdomain items, with
higher scores indicating a more positive safety climate. In this
study, each domain’s Cronbach’s a was between 0.71 (perception of
management) and 0.92 (working conditions).
Seven additional questions covered the demographics of the
respondents (gender, age, education level, profession, and work
experience) and the characteristics of the hospitals where they
worked, including ownership (public or private) and size of the
hospital (secondary or tertiary).
Ethical Considerations
This study was conducted with the approval of the Institutional
Review Board to which the researchers were affiliated (KNUT 2019-7).
All patients were informed about the study objectives and provided
informed consent.
Data Analysis
SPSS, ver. 23.0, (IBM, Armonk, NY) was used to analyze the data,
and a two-sided P-value under 0.05 was considered statistically
 Yoo et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx 3

significant. All participants’ characteristics were expressed by
descriptive or frequency analysis. The comparison of the measured
variables between groups was conducted using independent-
samples t test or analysis of variance. Pearson’s correlation co-
efficients were calculated to examine the correlation between orga-
nizational communication satisfaction and safety climate. To
conclude, multiple regression was performed to identify the factors
influencing safety climate.
Findings
Table 1 presents the participants’ characteristics. Most partici-
pants were female (98.06%) and staff nurses (87.38%). The mean age
was 29.54 ± 6.14 years, and participants had an average of
6.57 ± 5.84 years of nursing experience. Most (74.76%) worked in
private hospitals, and about half (52.43%) worked in tertiary hospitals.
Table 2 and Figure 1 shows that the highest-scored subdomain
of organizational communication satisfaction was supervisor
(3.48 ± 0.42), followed by horizontal informal communication
(3.45 ± 0.60), communication climate (3.08 ± 0.79), media quality
(3.07 ± 0.70), general organizational perspectives (2.75 ± 0.89),
personal feedback (2.73 ± 0.69), and organizational integration
(2.72 ± 0.77).
The highest-scored subdomain of safety climate was safety
climate (3.42 ± 0.68), followed by teamwork climate (3.42 ± 0.77),
job satisfaction (3.17 ± 0.85), working conditions (2.98 ± 0.70), and
perception of management (2.92 ± 0.96).
Table 1 shows job satisfaction scores were higher in nurses
working in secondary hospitals (t ¼ 1.99, P ¼ 0.049); scores on
perception of management (t ¼ 2.07, P ¼ 0.041) and working
conditions (t ¼ 2.16, P ¼ 0.033) were higher in nurses at private
hospitals. As presented in Table 2, all the subdomains of organi-
zational communication satisfaction had significant and positive
correlations with each subdomain of safety climate, with effect
sizes from low (r ¼ 0.27, P < 0.001) to medium (r ¼ 0.68, P < 0.001).
Before conducting multiple regression, the assumptions
regarding normality and absence of multicollinearity and outliers
were checked and verified. Table 3 shows each multiple regression
model was statistically significant, and the results are shown in
Table 3. Factors affecting teamwork climate were communication
climate (b ¼ 0.32, P < 0.001), media quality (b ¼ 0.43, P < 0.001),
and horizontal informal communication (b ¼ 0.17, P < 0.001);
factors affecting safety climate were media quality (b ¼ 0.48,
P < 0.001) and organizational integration (b ¼ 0.23, P ¼ 0.009); job
satisfaction was affected by working in secondary hospitals
(b ¼ 0.18, P ¼ 0.021), communication climate (b ¼ 0.35, P < 0.001),
and media quality (b ¼ 0.35, P < 0.001); perception of management
was affected by working in public hospitals (b ¼ 0.15, P ¼ 0.034),
media quality (b ¼ 0.49, P < 0.001), and personal feedback
(b ¼ 0.29, P < 0.001); and factors affecting working conditions were
working in public hospitals (b ¼ 0.17, P ¼ 0.043), media quality
(b ¼ 0.41, P < 0.001), and personal feedback (b ¼ 0.21, P ¼ 0.039).
Discussion
To the best of our knowledge, this is the first study to investigate
safety climate and communication satisfaction among Korean PACU
nurses. The results showed that safety climate was associated with
a higher level of communication satisfaction. Moreover, media
quality consistently affected all the subdomains of safety climate.
Therefore, these factors should be taken into account while
enhancing the safety climate in Korean PACUs.
Level of Safety
Overall, the level of safety climate in our study was similar to
that reported by Korean nurses in previous studies.20-22 The com-
parison of the means of patient safety climate between this study
and past research is shown in Table 4. However, because previous
studies did not provide specific figures for nurses working in PACU
and was conducted in a different research setting, we cannot

Table 1
Demographic Characteristics and Safety Climate of the Participants

n (%) Teamwork Climate Safety Climate Job Satisfaction Perception of Working Condition
Management

Mean ± SD t or F (P) Mean ± SD t or F (P) Mean ± SD t or F (P) Mean ± SD t or F (P) Mean ± SD t or F (P)

Gender
Female 101 (98.06) 3.41 ± 0.78 0.71 3.41 ± 0.68 0.35 3.17 ± 0.85 0.20 2.90 ± 0.96 0.49 2.98 ± 0.69 0.52
Male 2 (1.94) 3.80 ± 0.57 (0.481) 3.58 ± 0.12 (0.728) 3.60 ± 0.28 (0.477) 3.75 ± 0.71 (0.215) 3.00 ± 1.06 (0.968)
Education
3 Years 17 (16.50) 3.39 ± 0.93 0.01 3.50 ± 0.88 0.38 3.32 ± 0.99 0.80 3.09 ± 1.10 0.42 2.85 ± 0.84 1.50
BSN 81 (78.64) 3.42 ± 0.75 (0.986) 3.39 ± 0.65 (0.688) 3.12 ± 0.82 (0.452) 2.90 ± 0.94 (0.659) 3.03 ± 0.64 (0.229)
MSN 5 (4.85) 3.44 ± 0.79 3.60 ± 0.35 3.52 ± 0.77 2.70 ± 0.86 2.55 ± 1.01
Age
20s 70 (67.96) 3.39 ± 0.77 2.18 3.38 ± 0.68 0.28 3.09 ± 0.86 1.61 2.89 ± 0.92 1.63 2.97 ± 0.71 0.03
30s 21 (20.39) 3.67 ± 0.79 (0.119) 3.48 ± 0.78 (0.760) 3.47 ± 0.80 (0.206) 3.19 ± 1.06 (0.200) 3.01 ± 0.61 (0.974)
40s 12 (11.65) 3.10 ± 0.70 3.50 ± 0.46 3.15 ± 0.78 2.58 ± 0.91 2.98 ± 0.83
Working experience (years)
<2 25 (24.27) 3.66 ± 0.88 1.22 3.45 ± 0.71 0.69 3.31 ± 0.97 1.47 3.20 ± 0.95 1.59 3.11 ± 0.70 0.74
2e5 27 (26.21) 3.27 ± 0.72 (0.308) 3.29 ± 0.75 (0.560) 2.89 ± 0.73 (0.229) 2.66 ± 0.89 (0.198) 3.04 ± 0.72 (0.532)
5e10 31 (30.10) 3.41 ± 0.71 3.54 ± 0.64 3.29 ± 0.86 2.99 ± 0.93 2.85 ± 0.61
>10 20 (19.42) 3.32 ± 0.80 3.37 ± 0.60 3.17 ± 0.85 2.80 ± 1.05 2.95 ± 0.78
Position
Staff 90 (87.38) 3.43 ± 0.79 0.38 3.43 ± 0.69 0.48 3.16 ± 0.89 0.71 2.91 ± 0.96 0.10 3.01 ± 0.70 0.96
Charge 13 (12.62) 3.34 ± 0.67 (0.703) 3.33 ± 0.56 (0.096) 3.28 ± 0.49 (0.483) 2.94 ± 0.98 (0.921) 2.81 ± 0.65 (0.340)
Hospital owner
Private 77 (74.76) 3.49 ± 0.78 1.78 3.43 ± 0.71 0.34 3.22 ± 0.88 0.95 3.03 ± 0.92 2.07 3.06 ± 0.69 2.16
Public 26 (25.24) 3.18 ± 0.71 (0.078) 3.38 ± 0.56 (0.734) 3.04 ± 0.75 (0.346) 2.59 ± 1.00 (0.041) 2.73 ± 0.67 (0.033)
Hospital size
Secondary 49 (47.57) 3.54 ± 0.75 1.55 3.50 ± 0.68 1.13 3.35 ± 0.88 1.99 3.04 ± 0.92 1.25 3.03 ± 0.70 0.62
Tertiary 54 (52.43) 3.30 ± 0.79 (0.124) 3.35 ± 0.67 (0.261) 3.02 ± 0.79 (0.049) 2.81 ± 0.98 (0.214) 2.94 ± 0.69 (0.535)

BSN, Bachelor of Science in Nursing; MSN, Master of Science in Nursing.

Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
4 Yoo et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx

Table 2
Correlations Between Organization Communication Satisfaction and Safety Climate

Mean Standard 1 2 3 4 5 6 7 8 9 10 11
Deviation

Organizational communication satisfaction

1. Communication climate 3.08 0.79 1.00
2. Supervisor communication 3.48 0.42 0.29** 1.00
3. Media quality 3.07 0.70 0.57** 0.43** 1.00
4. Horizontal communication 3.45 0.60 0.24* 0.21* 0.37** 1.00
5. Organizational integration 2.72 0.77 0.42** 0.18 0.44** 0.12 1.00
6. Personal feedback 2.73 0.69 0.50** 0.38** 0.61** 0.26** 0.52** 1.00
7. Organizational perspective 2.75 0.89 0.49** 0.21* 0.51** 0.14 0.48** 0.54** 1.00
Safety climate
8. Teamwork climate 3.42 0.77 0.61** 0.28** 0.68** 0.41** 0.32** 0.44** 0.38** 1.00
9. Safety climate 3.42 0.68 0.44** 0.33** 0.58** 0.30** 0.44** 0.44** 0.35** 0.68** 1.00
10. Job satisfaction 3.17 0.85 0.55** 0.28** 0.57** 0.35** 0.29** 0.43** 0.27** 0.68** 0.48** 1.00
11. Perception of management 2.92 0.96 0.48** 0.33** 0.68** 0.27** 0.36** 0.59** 0.38** 0.72** 0.62** 0.71** 1.00
12. Working conditions 2.98 0.70 0.43** 0.33** 0.55** 0.27** 0.35** 0.47** 0.35** 0.57** 0.56** 0.47** 0.57**

* <0.05; **<0.01.

directly compare the results. However, the level of each safety
climate subdomain was slightly higher than in Albania,23 but much
lower than in Australia,24 China,25 Sweden,10 Saudi Arabia,26 and
Norway.27 Interestingly, Korea is highly developed in terms of
health care technology, but these findings suggest limited aware-
ness about safety climate issues.
Job Satisfaction
Job satisfaction was the highest-scored subdomain in other
countries but ranked third in the present study, indicating a low
level of job satisfaction among Korean nurses. Perceptions of
management earned the lowest scores, in line with previous
studies10,24; thus, more support from units and hospitals is urgently
needed to improve safety climate. On the other hand, the highest-
scored subdomain was safety climate, which was the lowest in a
study in China.25
Communication Satisfaction
The scores on communication satisfaction were consistent with
previous studies with nurses working in operating theaters22 and
university hospitals17,28 in Korea and public hospitals in South
Africa,29 but lower than those reported by intensive care unit nurses
in Belgium.30 The highest-scored subdomains were supervisor
communication and horizontal communication, which is consistent
with previous reports,17,28 whereas organizational integration, per-
sonal feedback, and organizational perspective scored lower. These
results indicated that nurses are the most satisfied with interper-
sonal communication but less satisfied with organizational aspects.
These results could be explained by the fact that the participants in
this study were staff nurses, who are involved in bedside nursing,
and their communication is usually task-oriented. Previous studies
also reported that nurses were the least satisfied with information
they received on organizational perspectives.28,30 Moreover, the
Korean tradition of elder respect rooted in the Confucian and the
Korean health care hierarchical organizational culture would
enhance the level of satisfaction with supervisor communication.
Nevertheless, organizational-level communication was the lowest
at 2.72, showing that an improvement is necessary, including
organizational policies and long-term plans, through open
communication and information sharing between the executive
level and individual nurses.
Findings also suggest that hospital ownership and size are
associated with safety climate. Specially, PACU nurses in public
hospitals had lower scores on working conditions and perception of
management; nurses in tertiary hospitals had lower scores on job
satisfaction. Generally, Korean public hospitals tend to be more
bureaucratic and hierarchical; thus, they need to improve their
working conditions and management systems to achieve a more
positive safety culture. Tertiary hospitals in Korea offer a more
specialized range of care despite the lack of nursing staff, which
would explain why nurses’ working satisfaction there is lower. This
result is in line with a study showing that smaller hospitals in
Australia had a more positive safety culture.24 In Korea, most highly
sophisticated operations are performed in tertiary hospitals. Thus,

Communication
Teamwork climate
climate

3.08 3.42
Organizational Supervisor
perspective 3.48 communication
2.75
Working conditions Safety climate
2.98 3.42

Personal feedback 2.73 3.07 Media quality

2.72 2.92 3.17

Organizational 3.45 Horizontal
Perception of
integration communication Job satisfaction
management

Figure 1. Scores on organization communication satisfaction and safety climate subdomains. This image is available in color online at www.jopan.org.

Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
 Yoo et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx 5

Table 3
Multiple Regression Analysis of Safety Climate

Teamwork Climate Safety Climate Job Satisfaction Perception of Working Condition

Management

b P В P b P b P b P

Gender (ref.: female) - - - - - - - - - -

Education: BSN (ref.: 3 years) - - - - - - - - - -
Education: MSN (ref.: 3 years) - - - - - - - - - -
Experience (months) - - - - - - - - - -
Position (ref.: staff nurse) - - - - - - - - - -
Hospital ownership (ref.: private) - - - - - - 0.15 0.034 0.17 0.043
Hospital size (ref.: secondary) - - - - 0.18 0.021 - - - -
Communication climate 0.32 <0.001 - - 0.35 <0.001 - - - -
Supervisor communication - - - - - - - - - -
Media quality 0.43 <0.001 0.48 <0.001 0.35 <0.001 0.49 <0.001 0.41 <0.001
Horizontal communication 0.17 0.017 - - - - - - - -
Organizational integration - - 0.23 0.009 - - - - - -
Personal feedback - - - - - - 0.29 0.001 0.21 0.039
Organizational perspective - - - - - - - - - -
R2 0.56 0.38 0.43 0.54 0.36
P <0.001 <0.001 <0.001 <0.001 <0.001

BSN, Bachelor of Science in Nursing; MSN, Master of Science in Nursing.

Blank cells indicate no relationship between variables in the model.

to enhance the safety culture in tertiary hospital PACUs, strategies
are needed to improve job satisfaction, such as lessening the
workload by increasing staffing levels.
All the organizational communication satisfaction sub-
domains were significantly associated with safety culture in
univariate analyses, and several subdomains significantly
affected safety climate in the multivariate analysis. Therefore,
nurses’ organizational communication satisfaction should be
considered when establishing a positive patient safety
climate. Effective communication between health care pro-
fessionals is critical to the safe delivery of care, and delayed
or inaccurate transfer of information can result in patient
harm and errors. 31 Media quality was particularly associated
with all the safety climate subdomains. The media quality
subdomain reflects nurses’ perceived level of the effective-
ness of the formats or channels used for hospital communi-
cation, such as well-organized meetings, clearly written
directives, and adequate amounts of communication time.16
For example, mobile technology is favored by health care
professionals and leads to improvements in communication
and teamwork.31,32 Therefore, adapting to new communica-
tion channels and developing effective communication sys-
tems is imperative to improve nurses’ satisfaction with
communication media.

Table 4
Comparison of the Means of Patient Safety Climate Between This Study and Past Research

Authors and year Country n Setting Teamwork Safety Job Perception of Working Stress
Climate Climate Satisfaction Management Conditions Recognition

This study Korea 103 Perianesthesia care 3.42 ± 0.77 3.42 ± 0.68 3.17 ± 0.85 2.92 ± 0.96 2.98 ± 0.70 -
units
Gabrani et al, Albania 132 Four regional 2.47 ± 0.41 2.62 ± 0.49 2.79 ± 0.52 2.17 ± 0.54 2.87 ± 0.46 2.87 ± 0.46
2015*,23 hospitals
Gallego et al, Australia 14,054 46 organizations 3.85 ± 0.52 3.92 ± 0.65 3.92 ± 0.65 3.47 ± 0.67 3.52 ± 0.73 3.65 ± 0.65
201224 (including (public health
46% system)
nurses)
Li et al, 2018*,25 China 441 Outpatient and 3.90 ± 0.62 3.98 ± 0.86 3.89 ± 0.79 4.32 ± 0.64 3.83 ± 0.98 3.83 ± 0.98
inpatient
departments, etc.,
of 13 public
hospitals
Groves et al, Sweden 146 Three hospitals 3.64 ± 0.63 4.12 ± 0.62 3.26 ± 0.65 3.55 ± 0.70 3.57 ± 0.87 3.57 ± 0.87
2011*,10 (one university, one
regional county,
and one local
county hospital)
Alzahrani et al, Saudi 363 Emergency 3.61 ± 0.60 3.92 ± 0.83 Unit Management: 3.59 ± 0.82 3.28 ± 0.97 3.28 ± 0.97
2018*,26 Arabia departments of two 3.36 ± 0.80;
public hospitals Hospital
Management:
3.27 ± 0.82
Bondevik et al, Norway 78 Five nursing homes 3.82 ± 0.72 4.22 ± 0.74 - 3.91 ± 0.59 4.12 ± 0.72 4.12 ± 0.72
2017*,27

SAQ, Safety Attitudes Questionnaire.

SAQ scores of registered nurses' subgroups are shown.
*
0-100 scores were converted into 1-5 score for comparison {(“domain score”/25)-1}.

Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
6 Yoo et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx
Limitations
There are several limitations to this study. First, we used data
from a cross-sectional survey; therefore, the findings demonstrate
association but not causality between communication satisfaction
and safety climate. Second, the results did not provide specific
safety data, such as number of medical errors or adverse events.
Despite these limitations, this study contributes knowledge about
the factors affecting the patient safety climate among Korean
nurses in PACUs. The strength of this study is its inclusion of nurses
through a nationwide organization, which enhances the repre-
sentativeness of our results.
Conclusions
This study found that Korean PACU nurses reported poorer safety
climates than nurses in many other countries. Despite its highly
developed health care technology, Korea continues to lag behind in
the area of patient safety, and a more effective patient safety policy
and culture is needed. Efforts at governmental and organizational
levels should keep patient safety as the main priority. One possible
strategy is to enhance satisfaction with communication among health
care staff by developing effective communication media that satisfy
users. It is also necessary to promote organizational communication,
for example, increasing individual health care professionals’ knowl-
edge of their organization’s visions and policies.
Acknowledgments
The authors gratefully acknowledge the contribution of the
nurses who agreed to take part in this study.
References
1. Olds DM, Aiken LH, Cimiotti JP, Lake ET. Association of nurse work environment
and safety climate on patient mortality: A cross-sectional study. Int J Nurs Stud.
2017;74:155e161.
2. Makary MA, Daniel M. Medical error-the third leading cause of death in the US.
BMJ. 2016;353:i2139.
3. Park JY. The Current State of Medical Error in South Korea. Sch J Appl Sci Res.
2018;1:28e33.
4. Hwang JI, Chin HJ, Chang YS. Characteristics associated with the occurrence of
adverse events: A retrospective medical record review using the Global Trigger
Tool in a fully digitalized tertiary teaching hospital in Korea. J Eval Clin Pract.
2014;20:27e35.
5. Lee W, Kim SY, Lee SI, Lee SG, Kim HC, Kim I. Barriers to reporting of patient
safety incidents in tertiary hospitals: A qualitative study of nurses and resident
physicians in South Korea. Int J Health Plann Manag. 2018;33:1178e1188.
6. Institute of Medicine Committee on Quality of Health Care in America. In:
Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: Building a safer
health system. Washington, DC: National Academies Press; 2000.
7. Kim KO. A first step toward understanding patient safety. Korean J Anesthesiol.
2016;69:429e434.
8. Hartmann CW, Meterko M, Rosen AK, et al. Relationship of hospital organiza-
tional culture to patient safety climate in the Veterans Health Administration.
Med Care Res Rev. 2009;66:320e338.
Please cite this article as: Yoo J et al., Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit
Nurses, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.04.009
9. Antonsen S. Safety culture: Theory, method and improvement. Boca Raton, FL:
CRC Press; 2017.
10. Groves PS, Meisenbach RJ, Scott-Cawiezell J. Keeping patients safe in healthcare
organizations: A structuration theory of safety culture. J Adv Nurs. 2011;67:
1846e1855.
11. Rodziewicz TL, Hipskind JE. Medical Error Prevention. Tampa, FL: StatPearls
Publishing; 2019.
12. Kim FJ, da Silva RD, Gustafson D, Nogueira L, Harlin T, Paul DL. Current issues in
patient safety in surgery: A review. Patient Saf Surg. 2015;9:26.
13. Olsen SW, Draborg E, Lisby M. Physicians’ and nurses’ attitudes and actions
regarding perioperative medication management. J Perianesth Nurs. 2019;34:
614e621.
14. Blomberg AC, Bisholt B, Lindwall L. Responsibility for patient care in periop-
erative practice. Nurs Open. 2018;5:414e421.
15. Kaafarani HM, Itani KM, Rosen AK, Zhao S, Hartmann CW, Gaba DM. How does
patient safety culture in the operating room and post-anesthesia care unit
compare to the rest of the hospital? Am J Surg. 2009;198:70e75.
16. DeConinck J, Johnson JU, Busbin JA, Lockwood FR. An examination of the val-
idity of the Downs and Hazen communication satisfaction questionnaire.
Marketing Manag J. 2008;18:145e153.
17. Kim KJ, Han JS, Seo MS, et al. Relationship between intra-organizational
communication satisfaction and safety attitude of nurses. J Korean Acad Nurs.
2012;18:213e221.
18. Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire:
Psychometric properties, benchmarking data, and emerging research. BMC
Health Serv Res. 2006;6:44.
19. Jeong H-J, Lee W-C, Hyeon S, et al. An efficiency-oriented reform of safety at-
titudes questionnaireeKorean version (Development of SAQ-K2). Biom Biostat
Int J. 2019;8. https://doi.org/10.15406/bbij.2019.08.00277.
20. Hwang JI, Hwang EJ. Individual and work environment characteristics associ-
ated with error occurrences in Korean public hospitals. J Clin Nurs. 2011;20:
3256e3266.
21. Je SM, Kim HJ, You JS, et al. Assessing safety attitudes among healthcare pro-
viders after a hospital-wide high-risk patient care program. Yonsei Med J.
2014;55:523e529.
22. Kwon E-Y, Park K-Y. Perception of patient safety culture, intra-organizational
communication satisfaction and factors influencing patient safety nursing ac-
tivities among operating room nurses in small- and medium-sized hospitals.
Health Soc Welfare Rev. 2019;39:428e452.
23. Gabrani A, Hoxha A, Simaku A, Gabrani JC. Application of the Safety Attitudes
Questionnaire (SAQ) in Albanian hospitals: A cross-sectional study. BMJ Open.
2015;5:e006528.
24. Gallego B, Westbrook MT, Dunn AG, Braithwaite J. Investigating patient safety
culture across a health system: Multilevel modelling of differences associated
with service types and staff demographics. J Healthc Qual. 2012;24:311e320.
25. Li Y, Zhao Y, Hao Y, et al. Perceptions of patient safety culture among healthcare
employees in tertiary hospitals of Heilongjiang province in northern China: A
cross-sectional study. J Healthc Qual. 2018;30:618e623.
26. Alzahrani N, Jones R, Abdel-Latif ME. Attitudes of doctors and nurses toward
patient safety within emergency departments of two Saudi Arabian hospitals.
BMC Health Serv Res. 2018;18:736.
27. Bondevik GT, Hofoss D, Husebo BS, Deilkas ECT. Patient safety culture in
Norwegian nursing homes. BMC Health Serv Res. 2017;17:424.
28. Kim Y, Jang SJ. Nurses’ organizational communication satisfaction, emotional
labor, and prosocial service behavior: A cross-sectional study. Nurs Health Sci.
2019;21:223e230.
29. Wagner JD, Bezuidenhout MC, Roos JH. Communication satisfaction of pro-
fessional nurses working in public hospitals. J Nurs Manag. 2015;23:974e982.
30. Vermeir P, Blot S, Degroote S, et al. Communication satisfaction and job
satisfaction among critical care nurses and their impact on burnout and
intention to leave: A questionnaire study. Intensive Crit Care. 2018;48:21e27.
31. Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi A. The impact of
mobile technology on teamwork and communication in hospitals: A systematic
review. J Am Med Inform. 2019;26:339e355.
32. Wagoner M, Snyder S, McCarty M, et al. Routine disinfection of mobile
communication devices in the postanesthesia care unit. Perianesth Nurs.
2019;34:1176e1180.