1. Department of Nursing, Faculty of Paediatric Nursing, Ghana College of Nurses and Midwives, Tamale Training site, Ghana.
2. Department of Mental Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana.

* Correspondence: baluuroben@gmail.com

Keywords: pediatric patient, safety practices, hospitalized children

1. INTRODUCTION

Patient safety is a common goal for nurses and other healthcare providers in the health care setting. Health care providers work hard to provide the maximum level of safety that patients expect from their treatment. Despite the fact that the phrase “patient safety” is frequently used, it is possible that diverse healthcare stake holders do not all agree on what it means. In fact, data reveal that patients and medical professionals may have distinct concepts or understandings of patient safety [1]. This means that although patients and healthcare workers share a goal for patient safety, they may have conflicting perspectives on the idea itself. Patient safety has numerous definitions, but [2], referenced by [3], state that, it is simply the avoidance, prevention, and amelioration of negative outcomes or injuries resulting from the healthcare process. Patient safety is also defined by the World Health Organization (WHO) as the absence of avoidable injury to patients and the avoidance of needless harm by healthcare providers [1]. The term patient safety is again, viewed as the reduction, to the minimum acceptable level, the risk of needless and preventable harm arising from healthcare processes [4]. Hospitalized children’s safety is a key component of the standard of care, and this includes programs to lower medical errors and make healthcare safer. Poor hospitalized children’s safety is a result of systemic shortcomings, and not the individual failure [5]. Ensuring patient safety involves the coordination of multidisciplinary efforts within the healthcare setting, of which nurses take a center stage. In Ghana, healthcare quality assessment by patients and care providers indicates that, the quality of healthcare services expected by clients is inadequate and suboptimal [6]. This is as a result of many factors influencing safety practices of health care givers. As a result of this, more attention has been directed towards improving the quality of healthcare services and ensuring hospitalized children’s safety. Much policy focus has been directed to ensuring quality and safety of patients in healthcare settings [7]. Adverse Events (AEs) are unanticipated harms or side effects that are brought on by medical care rather than the patient’s underlying illness [8]. Patient safety in hospitals is at risk due to the occurrence of adverse events and medical errors. The greatest worry for patient safety in healthcare settings is hospital errors, which are one of the biggest issues in the health system [9]. Medical errors are caused by a variety of factors, including the lack of knowledge and inadequate expertise of healthcare professionals. This demonstrates the critical need of providing high-quality, safe health care in the context of global health [10] cited by [11]. Adverse events can lead to death, disability, and prolonged hospital stay. Although all levels of care make efforts to prevent adverse events, there is evidence that adverse occurrences happen among hospitalized children in Ghana. The World Health Organization estimates that, one in every ten patients worldwide suffers from mistakes and unfavorable outcomes that may have been prevented in their treatment [12]. These unfavorable incidents include patient falls, injection abscesses, and infections in surgical wounds. Others include hospital-acquired diseases and patient injuries or accidents [9]. Different nations are required to monitor, strengthen, and evaluate the culture of patient safety, according to a WHO resolution from 2002. Due to the tremendous drive to increase patient safety as a global priority, it is equally important to foster a safety culture among the medical team [13]. Hospitalized children’s safety is at the core of modern healthcare, and interventions that can affect safety are becoming more and more evident. Despite all these, the issue of pediatric patient safety has not been adequately addressed in Ghana, particularly the current study environment. Hospitalizations in European nations with advanced healthcare systems account for 8 to 12 percent of adverse occurrences [14]. A cross-sectional and analytical study carried out in two adult intensive care units in a Brazilian teaching hospital in 2017 and 2018 among 84 healthcare providers indicate a negative safety climate [15]. According to a study done in London on 47 hospitalized children, the following factors contributed to each patient’s major adverse events (ADEs) or critical incidents: Patient variables make up 2%, followed by task factors making up 3%, provider factors making up 60%, team factors making up 27%, and work/organizational aspects 8% [16]. The majority of medical personnel that interact with hospitalized children most frequently are nurses. Through patient assessment, care planning, monitoring, and surveillance activities, nurses are expected to follow organizational methods for recognizing risks and harms. To ensure hospitalized children’s safety, nurses are required to follow protocols including double-checking, providing support, and communicating with other healthcare professionals [4]. Thus, nurses’ actions are crucial for the adoption of safe practices and the provision of better healthcare for children who are hospitalized [17] cited by [7]. Therefore, in order to gather background data and highlight the factors affecting pediatric patient safety, and finding solutions to the problem, the nurses are the best source of such information. Knowing nurses’ opinions on the variables that affect pediatric patient safety would be beneficial for the creation and application of improved solutions, given the significance of nurses with regard to patient safety [18]. It is also conceivable that their perceptions could be used to pinpoint lesser-known patient safety problems. Additionally, it is likely that solutions based on the perspectives of nurses are more successful. This is greatly contributed to the preservation of pediatric patient safety at the hospital. One of the top 10 causes of disability and mortality worldwide is the harm caused to hospitalized children during the delivery of medical care [8]. According to estimates, one in ten patients receiving hospital care worldwide face safety difficulties, ranking as the 14th leading cause of the global burden [19]. In developing nations, up to one in four children experience at least one incidence of harm while in the hospital [20]. According to the available data, 134 million adverse events caused by subpar treatment take place in hospitals in low and middle-income countries every year, resulting in around 2.6 million fatalities [21]. This study explored the factors influencing safety practices of nurses at the TWH.

2. MATERIALS & METHOD

The study was conducted in the pediatric ward of Tamale West Hospital (TWH) in the Northern Region of Ghana. TWH is located in the Tamale Metropolis. The pediatric ward has a bed capacity of 60 and a staff strength of 56 nurses. The Tamale West hospital serves as a referral Centre for clinics and nearby districts like, Tolon, Kumbungu, Central Gonja, Savelegu, and Nanton, all in the Northern Region of Ghana. It provides 24-hour services, and renders services including medical services, Antenatal care (ANC) services, Ear, Nose and Throat (ENT) services, Neonatal Intensive Care (NICU) services, Prevention of mother to child transmission (PMTC) and Voluntary Counseling and Testing (VCT) Services, Laboratory and X-ray Services, Ultra Sound Service, Eye Clinic, Gynecological Services, and surgical services. The hospital is also an NHIS accredited facility. A descriptive exploratory qualitative approach was used in this study. The targeted population for this study was nurses at Tamale West Hospital. This study targeted the nurses because they are the major stakeholders in patient care at the hospital. They are also major implementers of safety protocols at the hospital to ensure patient safety. Again, nurses spend most of the time with the patients and may have better understanding of the topic under study. The population characteristics included; Pediatric Nurses, Registered General Nurses (RGN), and Enrolled Nurses (EN). The sample size included twelve (12) nurses who work at the children’s ward of TWH. In qualitative research, the sample size should not be too small to create difficulties in achieving data saturation, neither should the size be too high to pose challenges in undertaking in-depth case-oriented studies [26], cited by [12]. The sample size was however dependent on data saturation. Data saturation is often described as the point in data collection when new incoming data produce little or no new information to address the research question [10]. Data saturation was reached by the time 12 participants were interviewed. Purposive sampling technique was used to select participants who met the inclusion criteria to share their views on the factors affecting the safety of hospitalized children at Tamale West Hospital. A semi-structured interview guide developed by the researcher according to the objectives of the study was used for the data collection. This semi-structured interview guide was chosen because it offers participants the opportunity to express their views about the phenomenon. It also enables the researcher to seek for clarifications by asking probing questions. The interview guide was made up of four sections; section A contained questions on demographic data. Section B contained questions to explore nurse-related factors that influence the safety of hospitalized children. Section C contained questions to explore the ward-related factors influencing the safety of hospitalized children, and Section D contained questions to identify patient-related factors that influence the safety of hospitalized children. The study obtained an ethical clearance from Ghana Health Service (GHS) ethics review committee. The participants were asked open-ended questions and probes used when necessary. Content analysis was used to analyze the data. This method was used for the data analysis because of its reliability as it follows systematic procedures/steps to analyze the data.

3. RESULTS & DISCUSSION

A total of twelve nurses participated in the study. As presented in table 4.1 below, the age range of nurses interviewed was 29 – 37 years. Seven of the participants were males, and five were females. Regarding academic qualification, seven of the participants had a first degree in nursing, three had a diploma in nursing, and two had certificate in nursing. Six of the participants were nurses with specializations in pediatric nursing. Four of the participants were Registered General Nurses (RGN), and two of the participants were enrolled nurses (EN). The work experience of the participants ranges from 3 to 10 years.

Table 01: Background Characteristics of Participants

A total of five themes and twenty-four sub-themes were identified. These themes include: ward-related factors, nurse-related factors, patient-related factors, task-related factors and team-related factors. Ward-related factors describe the conditions within the ward environment that influence safety practices. These factors affect pediatric patient safety either positively or negatively. Nurse-related factors refer to the qualities of the nurse that influence pediatric patient safety in the ward. Nurses are the majority in the health care setting and their abilities and inabilities affect the safety of hospitalized children. Patient-related factors are those characteristics of the patient that influence their safety in the ward. Children have very unique characteristics that may expose them to safety threats at the hospital. Task-related factors involve nursing practices and activities that have an impact on the safety of hospitalized children. Team-related factors considered the collaboration between health teams to provide the needed health care services for patients. This involves working with other health teams, staffs, and patient relatives to ensure quality care.

Table 02: Main Themes and Sub-themes

Inadequate staffing was perceived by majority of the nurses as a major factor that affected pediatric patient safety in the ward. The participants alluded to the fact that there are always a lot of children on admission, but only few nurses are mostly on duty to handle these high numbers. According to participants, three to four nurses are mostly put on duty to manage the ward with over forty patients. This affected pediatric patient safety negatively in the ward. The participants attributed some of the mistakes that endangered the lives of the patients to increased workload as a result of inadequate staffing. They explained that, a lot of safety measures or protocols are overlooked when the nurses are stressed up with so much work in the ward and cannot even think and make decisions properly. Some of the participants indicated that, there were a lot of patients under the care of fewer nurses on duty resulting in pressure and stress on them. The nurses become overwhelmed by the number of patients and anything can happen. According to the participants, a stressful environment is prone to mistakes and patient harm. The participants mentioned limited space for nurses and patients to move around freely and conduct their normal procedures without hindrances as a factor that affects pediatric patient safety. Working within a limited space poses a challenge in ensuring pediatric patient safety in the ward as perceived by the participants. According to participants, movement in the ward becomes very difficult, and the space needed to prepare medicines or carry out nursing procedures is not there. The ward always looks very congested due to limited space and does not facilitate the safety of hospitalized children. Inadequate logistics was identified by the nurses as a major factor that affected the safety of hospitalized children. Logistics are the equipment nurses are supposed to work with. But they are either not available or not enough. The participants also stressed on the several challenges they face due to inadequate logistics, and the consequences on the safety of the children. According to participants, basic facilities, such as hand washing facilities, and medical equipment, such as oxygen concentrators, oxygen cylinders, and beds with side rails are not mostly enough. Participants also stated that, some important procedures cannot be carried out on patients who need those services due to lack of medical equipment. This according to participants affected pediatric patient safety in the ward. The participants held the view that, medical wastes and used items are not always appropriately disposed. They confirmed that, sharps and other waste items are always left carelessly on the ward, which expose children to needle pricks and injuries in the ward. According to participants, the sharp containers are kept insecurely in the ward and are not emptied in time, and children turn to play with used needles, leading to needle pricks. Participants were also worried that, children can get certain serious infections, such as; HIV, Hepatitis B, and other infectious diseases due to pricks from used needles left carelessly in the ward. The participants stated that, the physical structure of the ward does not ensure the safety of hospitalized children. They cited the walls, the floor, and the windows as examples of the structure that endanger the safety of the children. According to participants the children are exposed to bad weather conditions and falls. Participants also stated that, the tiles used for the ward floor are very smooth and slippery and the children easily slip and fall. The open nature of the ward was also a concern to participants, according to them, people can walk in and out of the ward at any time they want, which they said is not safe for the children. The nurse-related factors referred to various personal characteristics of the nurses that participants perceived to have affected the safety of hospitalized children. The participants identified several characteristics of individual nurses that affected pediatric patient safety in the ward. They included: knowledge of the nurse on patient safety, attitudes and practices of the nurse, skills and abilities of the nurse, work experience of the nurse, leadership, and nurse-patient relationship. The knowledge of the nurse on safety measures is very crucial in ensuring pediatric patient safety in the ward. Performing nursing procedures involve an adequate knowledge of the nurse in those areas in order to preserve the safety of the child. The participants believed that, nurses who have in-adequate knowledge or no training on pediatric patient safety are always unable to provide safe care to hospitalized children. Participants stated that, pediatrics is a specialized area of nursing, so general nurses do not have adequate knowledge in pediatric care, which sometimes put the children at risk of harm. According to participants, understanding and administering medication in pediatrics require sufficient knowledge to administer drugs without harming the children. In this subtheme, the participants strongly held the view that, the attitude and practices of the nurse in the ward is very paramount in ensuring the safety of the children on admission. They believed that attitude is everything as far as patient safety is concerned. From the participants’ perspective, poor or bad attitude and practices of nurses do not preserve pediatric patient safety in the ward. Nurses who do not adhere to safety protocols in the ward can endanger the children’s safety. According to participants, some nurses do not have good attitude towards the patients when they come on duty which does not ensure pediatric patient safety. The skills and ability of the nurse on the use of medical gadgets was also seen by participants as one of the factors that affected the safety of hospitalized children. The participants agreed that, the skills set of the nurse is very important in ensuring pediatric patient safety. According to participants, when medical gadgets are appropriately used on patients, they cause no harm to them. So, the nurse must have enough skills to use medical gadgets correctly to the benefit of the child without causing harm. Participants stated that, the skills and abilities of the nurse to use medical equipment accurately also facilitate immediate interventions, avoiding delays in dealing with patient problems. The participants also largely attributed medication errors to lack of experience in the profession. Participants believed that, newly posted nurses lack the necessary experience in patient care and pediatric drug administration. Thus, putting the safety of children in danger through errors. Participants also suggested that, newly posted nurses who have no experienced in the ward should not be put alone on duty, but rather with an experienced nurse. The participants identified nurse-patient/patient relative relationship as a major influencer in the safety of hospitalized children. They confirmed that, when nurses have cordial relationship with patients and patient relatives, it promotes pediatric patient safety in the ward. The patient and patient relatives are always ready to assist in ensuring patient safety if there is a cordial relationship between them and the nurses. According to participants, patients and relatives are always ready to share very vital information with the nurses when there is cordial relationship and respect between them and the nurses. Such information may be very crucial in preserving the safety of the hospitalized child. Patient-related factors was one of the main themes identified in the study. The participants identified patient condition/diagnosis, language barrier, age of the patient, and the family’s ability to afford treatment, as patient-related factors that influence the safety of hospitalized children. Language barrier between nurses and patients/patient relatives was perceived by the participants as a major factor that affected the safety of hospitalized children at the ward. The participants emphasized the need for understanding between the two parties. According to the participants, it has become challenging for them to get accurate information on patients due to language barrier. As a result, nurses are unable to give effective education on safety measures to such patients and relatives. According to participants, the patients come from various communities within the northern region, and speak different local languages. In situations where nurses on duty do not understand any of these languages and there is nobody to help them communicate with the patient and relatives, communication becomes a challenge. This may lead to delay in treatment or wrong diagnosis, and thus affects the safety of the child. Some of the participants also explained that, the inability of the children to communicate their feelings due to their developmental stage, affects their safety in the ward. Again, some medical procedures pose more risk in younger children than the older ones. The younger or smaller the child, the greater the risk of harm. According to the participants, these affect the safety of hospitalized children. The participants identified the patient’s inability to financially afford the cost of treatment as one of the factors that had an impact on pediatric patient safety in the ward. The participants indicated that children cannot afford their own medical bills, it is their relatives or family. However, there were situations where relatives and families could not take care of the medical bills of their children. This denied the child of the needed medical care and attention resulting in complications. These factors are nursing practices, activities and processes that the participants perceived to have an effect on the safety of hospitalized children. Various subthemes were identified from the data under the main theme; task-related factors. These subthemes are: drug administration, documentation, incident reporting, keeping medication with the patients, decontamination of items, and improper handing over. The participants indicated that, these activities or processes affected pediatric patient safety at the hospital. The participants indicated that, drug administration has both negative and positive impacts on patient safety. They also believed that when the drugs are administered correctly, the patient would be spared of adverse events and patient safety would be preserved. According to participants, drug administration in children needs a lot of attention and accuracy to prevent harm to the children, and must be done correctly. Nurses are tasked with the responsibility of correct drug administration to children on admission to avoid harm from medication errors. Some of the participants also confirmed that drug administration can cause harm to patients when it is not correctly administered. According to the participants, administering medication to children without following the rights of medication can be very dangerous to the child. The participants also held the view that medication errors are very common in the ward, affecting the safety of the children on admission. The participants believed that, once you performed a procedure or took patient information and you did not document, you have not done anything to help yourself and the patient in the ward. They insisted that accurate documentation of patients’ information had a positive influence on their safety in the ward. According to participants, when medications and procedures performed are well documented, the next staff is informed as to what was done for the patient and what needs to be done at what time. This practice of accurate documentation improves the safety of hospitalized children. Some of the participants were also of the view that, inadequate or poor documentation of patient details could be a barrier to their safety in the ward. The participants viewed documentation as a means of communication to other staffs in the ward, so if it is not properly done, it could lead to wrong medications and procedures on the patients on admission. Inaccurate documentation conveys the wrong or incomplete information about the child’s condition and may not give the correct picture of the situation. This will deny the child of the appropriate medical treatment. The participants also stated that, unclear documentation, such as written prescriptions, affect the safety of hospitalized children. They confirmed that, calculating correct dosages for administration becomes very difficult when the prescription is not clearly documented. Incident reporting was one of the subthemes identified from the study. According to participants, incidents that have the potential of causing harm to hospitalized children provided learning points for nurses, and this could lead to improved patient safety if measures are put in place based on the lessons learnt. However, participants stated that, these incidents that occur in many hospitals are not always reported due to the fear of being punished or dismissed. Feedback from incidents reports raised awareness, fostered further reporting, and led to initiatives for improved care, especially when several reports pointed in the same direction could be detected. The participants mentioned that, incidents at the ward are not mostly reported, though incident reporting is an important tool for improved patient safety in the ward. The participants confirmed that, incidents reporting has a positive impact for improved pediatric patient safety in the ward. They believed that, measures can be taken to curb the reoccurrence of certain adverse events when they are accurately reported and reviewed. They however stated that, measures are put in place to review reported incidence and address them appropriately to prevent reoccurrence. One of the important subthemes identified from the data was decontamination of items. Participants cited decontamination of items as one of the major factors that affect the safety of hospitalized children. According to the participants, medical items or equipment used on patients are always contaminated and can cause serious infections if they are used on another patient without decontamination. The participants thus considered decontamination as a factor that ensures pediatric patient safety. The participants believed that, proper hand hygiene and decontamination of used equipment before reuse is one of the surest ways of reducing the prevalence of nosocomial infections among hospitalized children. Participants agreed that, improper handing over affects the safety of children negatively in the ward. According to them, improper handing over does not ensure the continuity of care and may put the child’s life in danger. They also explained that, very vital information about the child and their treatment may not be known by the nurse taking over, which affects care and can lead to overdose of medication and inappropriate treatment. The study identified team factors as an important main theme. Participants explained team factors to be various aspects of the interactions between nurses and other health care providers that the nurses perceived to have influenced patient safety. According to participants, this involves collaborating with other people who have influence on pediatric patient safety in the ward. Working with other staffs and patient relatives were identified by the participants as important subtheme under team factors that influenced pediatric patient safety. Participants in the present study explained that, nurses who had higher levels of training, such as degree holders and nurse specialists adhere to patient safety protocols better than those with lower levels of training, such as diploma and certificate. Again, nurses who had further training on pediatric patient safety or nurses who specialized in pediatrics have a greater knowledge on patient safety than the general nurses. This finding agreed with that of [4], which revealed that, degree holders demonstrated higher understanding and adherence to safety measures in the ward than their diploma counterparts. An author [8] and colleagues concluded that, nurses who have higher academic qualifications may have more knowledge on patient safety as compared to those with lower academic qualifications. This implies that, the knowledge of the nurse in clinical practice is very key in the care of hospitalized children, and is gained through higher learning and work experience. This again, is an indication that, steps should be taken to train more nurses on pediatric patient safety. On the other hand, nurses who did not show good attitude towards their clients endangered the safety of the children under their care. Bad practices such as non-adherence to infection prevention protocols in the ward can compromised the safety of the children. Negligence and lack of monitoring on the part of nurses also affects the safety of the children. These findings confirmed the findings by [27], in their separate studies at different settings. They found that, individual factors such as nurses’ attitudes, perceptions, and knowledge can facilitate or hinder the use of clinical practice guidelines by nurses in patient care settings. This is an indication that, the attitude and practices of the nurse widely affect the safety of hospitalized children. Nurses therefore need to exhibit positive work attitude towards their patients in order to provide quality services and reduce harm. This supports the findings from the qualitative study conducted by [28] which concluded that, patient safety is facilitated by several skills and abilities of the nurse, such as having the capacity to learn from mistakes, being prepared for risks, and generally being proactive in everyday work situations. This current study also used a qualitative approach to get an in-depth understanding of the problem. The findings of this study also indicated that, work experience of the nurse is very paramount in ensuring patient safety in the ward. As nurses continue to work, they gain a lot of experience in providing care and improving patient safety. So, nurses who have a lot of experience in child care are in a better position to contribute positively to improved patients’ safety in the ward. This corresponds to the findings of a study by [8] which indicated that, nurses who work in the ward for a longer period tend to have adequate knowledge on pediatric patient safety than those who have less work experience in the ward. Also, in this current study, adverse events were associated with newly posted nurses who were seen to have no work experience in ensuring pediatric patients’ safety. These further buttresses the finding that, work experience affects pediatric patient safety in the ward. It is also suggested from this current study that, newly posted staffs who have no experience in child care should be paired with an experienced staff, so that they learn from them. This finding corresponds to the findings of a study conducted by [11], where they concluded that, regular practical feedback processes, interaction opportunities and observation of peers and senior colleagues, and leadership motivate nurses’ adherence to daily safety measures. This finding emphasized the need to ensure skill mix in assigning staffs to duties, so that, the experienced staff guide and motivate the junior staffs to promote adherence to safety protocols in the ward. This also create a learning environment for the junior staffs. Limited space does not allow free movement within the ward which can lead to falls. This finding from the present study is consistent with that of other studies that indicate that patients are most likely to suffer from medical errors or harm in ward environments where nurses do not have enough space for the preparation and administration of medicine [28]. Children need space to play around when they are getting better, and nurses also need enough space to perform nursing activities, such as; drug administration and cannulation. So, when there is no space for these activities, both staffs and children are at increased risk of harm. This finding shows that, more space is needed to tackle the issues of overcrowding in order to ensure patient safety. The current study confirmed that, patient condition affects their safety in the ward. Children with complex health conditions and children with special health needs are likely to experience harm in the ward. Special conditions demand special care by specialist nurses. However, due to the shortage of nurse specialists at the hospital, children with such conditions are taken care of by general nurses who have limited knowledge in the care of such children. This increases the risk of harm to these children in the ward. It is also clear from this study that, children who are restless are always prone to falls from beds because the beds have no side rails to protect them. This finding corresponds to the findings from other studies that concluded that, children with medical complexity have increased healthcare utilization and experience frequent transitions between care environments, increasing the opportunity for care fragmentation and error [12]. The finding is an indication that, planning health care for children without considering the unique nature of the child’s condition will gravely affect their safety. Every child is unique in their own way, planning care for children should be individualized to meet the health needs of the child. Again, in this study, it was revealed that the age of the child is another factor that affects their safety in the ward. A study conducted among 63 children aged 12 to 17 years who were on admission, suggests that, children of all ages may experience a range of fears that can affect their safety at the hospital [18]. However, the present study findings suggest that, younger children are more prone to harm than the older ones who understand basic safety protocols. Nurses find it very difficult in communicating with children who do not speak or understand when spoken to due to their age. This makes education very difficult. Such children do not also cooperate during medical procedures because they do not understand anything. They also turn to play in a dangerous environment with dangerous objects like sharps that easily cause harm to them in the ward. This finding concurred with that of [9], who found in their study that, demographic characteristics of the patient, such as age, sex, and possibly ethnicity, have an influence on their safety at the hospital. There are several task-related factors that affected the safety of hospitalized children aside the ward-related, nurse-related and patient-related factors. Participants expressed an in-depth knowledge on these task-related factors that they believed affected pediatric patient safety at the Hospital. They gave detailed explanation of some of these key factors that affected patient safety. These factors are: drug administration, documentation, incident reporting, keeping medication with the patients, decontamination and improper handing over. It is evident from this study that, incident reporting influences patient safety greatly in the pediatric ward. The participants attested to the fact that, incidents did happen in the ward, but most of them were not reported for actions to be taken because of fear of being punished. When incidents are not reported, it affects patient safety negatively. This is because the same problems will continue to recur in the ward. The findings also suggested that, incidents are not reported because of fear of losing one’s job or being punished for the action. In many hospitals within Ghana, patients’ medications are always kept with them in the ward, both oral medications and intravenous infusions, including other formulations. The findings of this current study indicated that, keeping drugs or medications with the patients poses a safety risk to the children. The findings also revealed that, some relatives administered the medication to their patients on their own without the nurses’ supervision. This practice exposed the children to drug overdose and medication related complications, and affected patient safety negatively in the ward. This suggests that, more effort needs to be put in educating the patients and relatives on the dangers associated with such practices. This current study suggests that, improper handing over affected the safety of hospitalized children. Patient care is a team work, and nurses run the shift system, handing over of care to the next staff is very crucial in ensuring the continuity of safe care. Participants indicated that, when proper handing over protocols are not followed, vital information about the child may be missing, and thus affect the safety of the child. This finding confirmed the findings from other studies which indicate that, the provision of a standard process for handover, such as a validated handover tool, enables performance of handovers at the patient bedside, and thus promotes the safety of hospitalized children [25]. This suggests that, having a standard handing over tool or protocol in the pediatric unit will contribute immensely to improved patient safety among hospitalized children. Proper handing over practices helps prevent basic but harmful procedural and medication errors in the ward.

4. CONCLUSIONS

Patient safety is a very critical aspect of health care delivery at the health facilities across the country. In every health facility in Ghana, patient safety is always a priority, as far as patient care is concerned. The safety of hospitalized children needs to be ensured in all aspect of the care given to them. Providing care to children in a complex environment by different units and individuals may result in some harm to the children. Hospitalized children however, experience various adverse events at the hospital that affect their safety. The study was conducted at the pediatric ward of TWH located in Tamale metropolis, northern region, Ghana. The target population was nurses at the pediatric ward. A qualitative research approach was used in this research. Data were collected from participants using a semi-structured interview guide. Purposive sampling technique was used to select participants for the interview. Individual face-to-face and virtual interviews were used to collect the data. A total of twelve nurses were interviewed. Six were pediatric nurses, four were registered general nurses, and two were enrolled nurses. In terms of gender, five were females and seven were males. Participants were aged between 29 – 37 years, with work experience of 3 – 10 years. The data were analyzed using content data analysis approach. The study identified many key factors influencing pediatric patient safety at the hospital. These factors are related to the individual nurse, the ward, the patient, and other factors related to nursing practice. The nurse-related factors include; knowledge level, attitude and practices, work experience, skills and abilities. The ward-related factors identified are; inadequate staffing, limited space, lack of logistics, ward arrangement, and physical structure of the ward. The age, diagnosis, language barrier, and ability to afford treatment, were the patient-related factors identified. Other factors related to nursing practice, such as; documentation, incident reporting, decontamination, and sharp disposal were also found to have a great influence on pediatric patient safety. Participants are of the view that, pediatric patient safety in the ward are improved if these factors are adequately addressed. The study revealed that, several factors relating to nursing practices affect the safety of hospitalized children. Nurses are the major stakeholders in the hospital and play a very vital role in patient safety. The key factors identified in this study are very useful for the management of the hospital and policy makers to shape nursing practice and improve the safety of hospitalized children. The findings of the study underscored the need to educate patients and relatives on the child’s condition and ward protocols. Educating patients and relatives will empower them to support the children and ensure their safety in the ward. They also adhere to the safety protocols in the ward better when they are educated on them. Nurses who spend the maximum time in coordinating and providing care to the patients are highly responsible in strengthening the safety of patients care. Thus, the nurses should have the desire to upgrade their knowledge, inculcate a positive attitude regarding patient safety, and incorporate it into their practice to promote safety. It is the researcher’s belief that, the findings of this study will form a useful basis for discussions on how improved pediatric patient safety can be achieved among nurses at the hospital. Nurses are the majority in health care settings, and patient safety would be improved if more researches are conducted into nursing practices that affect pediatric patient safety in the ward.  Again, there is limited research data on pediatric patient safety in Ghana, making it very necessary for more researches to be conducted in this area. This will make reliable and evidenced based information available for policy planning and improvement of pediatric patient safety. This study was to explored the factors influencing safety practices of nurses in the care of hospitalized children. This study added new knowledge to the existing body of knowledge on pediatric patient safety, and specifically, highlighted the various factors that affected the safety of hospitalized children. A broad range of factors are important for patient safety according to the study findings. The study also uncovered important factors that are related to the individual nurse, the patient, the ward environment, and other factors that have bearing in the safety of hospitalized children in the Ghanaian context. The factors affecting pediatric patient safety are at multiple levels, indicating that, complex multifaceted initiatives are needed to address pediatric patient safety issues. The factors identified in this study also call for more attention in order to address these factors appropriately to improve pediatric patient safety.

REFERENCES

1. Afenyo, M. A. (2019). Knowledge of child rights in ghana : Implementation of article 42 of the united nations convention on the rights of the child. july. Dissertation submitted to the university of Ghana , Legon.
2. Akologo, A., Abuosi, A. A., Anongeba, E., & Id, A. (2019). A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana. 1–13.
3. Justice Badam Parmaak (2024). A Review on Occupational Health & Safety Implementation Protocols of the Mining & Petroleum Industries in Ghana. Dinkum Journal of Medical Innovations, 3(08):609-618.
4. Barrow, E. J., & Hons, H. M. (2018). Putting the patient in patient safety : qualitative exploration and co-design of a new paradigm. October. A thesis presented for the degree of Doctor of Philosophy ( PhD ).
5. Biresaw, H., Asfaw, N., & Zewdu, F. (2020). Knowledge and attitude of nurses towards patient safety and its associated factors. International Journal of Africa Nursing Sciences, 100229.
6. Chad G. B. (2021). The impact of documentation burden on patient care and surgeon satisfaction. 64(4), 457–458.
7. Comprehensive medication management. (2019). Patient Safety : Bridging the Information Gap. 129.
8. Anisha Shrestha, Archana Pandey Bista, Kalpana Paudel & Madhusudan Subedi (2024). Experiences of Nurses Regarding Caring Behavior in Intensive Care Units. Dinkum Journal of Medical Innovations, 3(07):483-492.
9. Davis, R. E., Mrcs, R. J., Sevdalis, N., & Vincent, C. A. (2007). Patient involvement in patient safety : what factors influence patient participation and engagement ? 259–267.
10. Dimitriadou, M., Merkouris, A., Charalambous, A., & Lemonidou, C. (2021). The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece : A comparative study. 1–12.
11. Elmontsri, M., Almashrafi, A., Banarsee, R., & Majeed, A. (2017). Status of patient safety culture in Arab countries : A systematic review.
12. Fitzsimons, J., & Vaughan, D. (2015). Top 10 Interventions in Paediatric Patient Safety. 275–285.
13. Fontana, R. T. (2018). Perceptions and knowledges about Pediatric Patient safety. 22(4).
14. Gaúcha, R. (2017). Patient safety in the care of hospitalised children : Evidence for paediatric nursing. 38(1), 1–9.
15. Ghana Health Service. (2011). Quality Assurance Strategic Plan for Ghana Health Service 2007-2011. September 2007.
16. Ii, P. G. B. (2013). Just Culture : A Foundation for Balanced Accountability and Patient Safety. 400–406.
17. (2021). World Patient Safety Day : Support the nursing workforce to deliver safe and respectful childbirth !
18. Kennedy-clark, S. (2012). Design research and the solo higher degree research student : Strategies to embed trustworthiness and validity into the research design. 2003, 1–12.
19. Lima, R. De, Nunes, S., Elisa, A., Camargo, B. De, Lima, J. C. De, Carvalho, D. E., Bernardes, C. A., Sousa, T. P., Raphael, F., Gimenes, E., Claudia, A., & Cordeiro, A. (2021). Factors influencing the patient safety climate in intensive care units : Cross- sectional study. 1–8.
20. Monroe, K., Wang, D., Vincent, C., Woloshynowych, M., Neale, G., & Inwald, D. P. (2011). Patient safety factors in children dying in a paediatric intensive care unit ( PICU ): A case notes review study. December 2015.
21. Rakesh Kumar Mahato, Sagar Pokharel & Avinash Sahani (2024). Knowledge & Practice Regarding Neonatal Resuscitation among Health Care Providers in Tertiary Care Hospitals of Nepal. Dinkum Journal of Medical Innovations, 3(03):257-270.
22. Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic Analysis : Striving to Meet the Trustworthiness Criteria. 16, 1–13.
23. Otchi, E. H., & Lartey, S. (2018). Patient safety situational analysis in Ghana. November.
24. Pascale C. and Kenneth E. (2011). NIH Public Access. 23–46.
25. Rages, S. S. (2014). Perceptions of Patient Safety Culture amongst Health Care Workers in the Hospitals of Northeast Libya Salem Saleh Rages. November 2014.
26. Ridelberg, M., Roback, K., & Nilsen, P. (2014). Facilitators and barriers influencing patient safety in Swedish hospitals : A qualitative study of nurses ’ perceptions. 13(1), 1–12.
27. Sharma, S., Peters, M. J., Nicu, P., & Action, R. (2013). ‘ Safety by DEFAULT ’ : Introduction and impact of a paediatric ward round checklist.
28. Tamale West Hospital. (2021). ANNUAL REPORT 2021.