The Impact of Nurses Clinical Decisions on Patient Safety and Quality of Care

Patient safety (PS) and quality of care are central to healthcare delivery, with clinical decisions playing a pivotal role in influencing outcomes. Objective: To assess the impact of clinical decisions on PS culture and the quality of care in tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan, and to identify key predictors influencing these outcomes. Methods: A cross-sectional analytical study was conducted from January to April 2025 in three tertiary care hospitals of KPK. A total of 384 participants (192 healthcare providers and 192 patients) were enrolled. PS culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC), and patient satisfaction was evaluated using the PSQ-18. An audit of 450 clinical decisions was also conducted. Descriptive statistics and inferential statistics were employed for data analysis using SPSS version 26.0. Results: Experienced staff (>5 years) reported significantly higher PS scores (3.96 ± 0.49, p<0.001). ICU/Emergency Departments had higher safety perceptions compared to medical and surgical units (p=0.041). Teamwork climate (4.15 ± 0.47) and supervisor expectations (3.96 ± 0.59) were rated highest among safety dimensions. Guideline non-adherence was significantly associated with adverse events (12.3% vs. 4.5%, p=0.018). Teamwork score (OR: 1.78) and experience (OR: 2.33) emerged as strong predictors of high safety culture. Conclusions: It was concluded that clinical decisions significantly affect PS and quality of care. Enhancing teamwork and experience-based leadership can strengthen safety culture, reduce adverse events, and improve patient satisfaction.