The Effect of Quality Accreditation Programs on Patient Safety Experiences in Nursing Services

The Quality Accreditation Programs (Quality Standards in Health, linked guidelines) that have been established by the Ministry of Health with the Health Transformation Project in 2003 and the Quality Accreditation activities that have gained momentum in the last 10 years are being implemented in all health institutions and organizations. Success in implementing the criteria set forth by Health Quality Standards; The physical locations of the institutions and organizations, the technical possibilities and the level of knowledge and experience of the personnel are significantly influencing.

It is important that the staff reflect their level of knowledge, especially their knowledge, on their experience. Patient safety is one of the most important aspects of quality programs in health care. Patient safety is all the measures taken by healthcare organizations and employees in order to prevent damage to health care services, and constitutes the primary and indispensable condition of qualified health care. The purpose of patient safety is to provide safety by creating an environment that physically and psychologically affects patient and patient relatives and hospital employees positively. The main goal here is to prevent errors during service delivery, to protect the patient from possible damage due to errors, and to eliminate the possibility of error.
It is important that the staff reflect their level of knowledge, especially their knowledge, on their experience. The most important quality programs in health services The topic of patient safety is a subject that should be taken up by all personnel working in health services [1]. Although it is not possible to reduce the medical errors caused by the health workers while providing health services, it can be seen that these errors and risks can be reduced to a minimum with the adoption of patient safety culture in hospitals and at the same time by all employees. The first goal in ensuring patient safety is to reduce risks The development of patient safety culture will also be significantly reflected in the experience. To protect patients from harm and to increase patient experience in the organization and to improve patient safety within the organization.
Patient safety-related events can cause harmful consequences for hospitalized patients and can bring an additional cost to the hospital. The damage suffered by the patient can cause serious injuries, prolonged hospital stay, disability, even death of the person. Human-

Collection of data
The research was conducted on April 2016. The questionnaire forms were distributed from the hands after the necessary explanations were made to the nurses by the investigator. The nurses were given 3 days to fill out the forms and after this time the questionnaires were collected again and collected from the hand.

Data analysis
The data obtained from the nurses participating in the study were transferred to the computer environment and evaluated in the SPSS 16.0 program. In the analysis of the data, descriptive statistical methods and square test in necessary subgroup analyzes were used. Analysis was made by CO Medical Research Consulting Company.

Results
When the distribution of nurses according to their personal and professional characteristics was examined (Table 1); 49.1% of them were between 25-34 years of age, 90.9% of them were associate and undergraduate graduates and 41.1% were 2-5 years in the institution. The rate of receiving education in nurses who had less than one year of working time was low (p=0.038). The rate of reporting on patient safety was significantly lower (p=0.049) in participants with less than one year and more than 10 years of study time.
When the findings of nurses regarding patient safety were evaluated (Table 2); Nurses reported that 98.9% had received patient safety training. 90.9% thought this training was sufficient. The rate of those who stated that they need education in this subject is 22.3%. 14.3% (n=25) and 8.6% (n=15) of those who stated that they were in need of training expressed their need for medical device safety training. The rate of participants reporting on patient safety was 78.3%. 62.9% (n=110) reported that they reported on "falling". The proportion of nurses who report in this issue between 25-34 age group was found to be significantly higher (p=0.012). In the study, 76.0% of the nurses stated that patient safety applications were adequate and 79.4% of the nurses said that quality programs contributed to their experience in Patient Safety [11].

Discussion
This research was carried out in a descriptive design to determine the factors that affect the patient's experience in patient care in nursing services.
When the distribution of nurses according to their personal and occupational characteristics was narrowed, it was determined that 49.1% of the nurses were between 25-34 years of age, 90.9% of them were associate and undergraduate graduates and 41.1% were 2-5 years of institutional work. The rate of receiving education in nurses who had less than one year of working time was low (p=0.038). The rate of reporting on patient safety was significantly lower (p=0.049) in participants with less than one year and more than 10 years of study time.
It was determined that 98.9% of the nurses stated that they had been educated about the patient safety and 90.9% of the training areas were sufficient. The training needs of employees for patient safety were 22.3% and they were found to have the most and the same (22.9%) training needs in terms of Radiation Safety and medical device safety. These findings show that the nurses in the investigated hospital are given trainings for patient safety but there are still training needs in some cases. In line with these findings, the training needs of the nurses induced problems such as fatigue, inadequate training, communication problems, timelessness, wrong decision, and argumentative personality can cause medical errors. The reasons such as workplace structure, policies followed, administrative structure, wrong distribution of personnel, inability to solve problems constitute institutional problems. Technical factors such as inadequate automation, inadequate equipment and missing equipment also affect the staff experience and may be the cause of medical error [2][3][4].
Implementation of event reporting activity in health services provides a better service for the patient by revealing the missing side of the worker involved in the organization, recognizing their strengths, developing their creativity, leading the organization in determining the responsibility and duty to be assigned within the organization Kohn et al. [5], Dursun et al. [1], Altındish and Kunt [6,7].
The main objectives of error reporting are to collect qualitative information that can be used for the development of the student as well as the collection of epidemiological data. Because the goal here is to ensure that the whole organization can learn from the experiences of people about mistakes and unwanted events.
Nurses carry out a large part of the patient care phase and medical activities in patient safety. Due to the fact that the nurses are a group of health personnel with the highest number of patients and the most number of patients, the establishment of patient safety culture in nursing practice has a big precaution [8][9][10]; Nurses are nested with patient safety in all aspects of care. In order to talk about the culture of patient safety in an institution, it is necessary to increase the patient safety experience and the adoption and continuity of patient safety applications by the nurses.

Goal
This study was conducted to evaluate the contribution of Quality Accreditation programs to patient safety knowledge and practice in nursing services and to measure the effects of different variables on these applications.

Research Questions:
• What are the conditions for receiving patient safety training?
What are the training requirements?
• What is the status of nurses reporting incidents related to patient safety?
• Is there a relationship between nurses' status of patient safety education and patient safety practices at the institution?

Type of study
The study was carried out in a descriptive design.

Sample of the study
The study was conducted with 175 nurses working in different age groups, different education levels, hospital clinics and with different work experience periods.

Data collection tools
"Survey Form" was used to collect research data. The data were obtained through a questionnaire consisting of 12 questions (there are subdivisions of the two problems). and nurses should be assessed with certain intervals and the training programs should be arranged and the training should be repeated In the study, the reporting rate for patient safety practices was low (78.3%) and the reporting of the highest decrease was reported, the percentage of nurses reporting this issue between 25-34 age group was significantly higher (p=0.012) (P=0.049) at a significantly lower level during the study period of less than 10 years. Is a subject that needs to be emphasized. Reporting of faults is considered one of the most important indicators of patient safety culture in an institution. Although the rate of nurses receiving training on patient safety practices was high, the reporting rate was low. This shows us that the attitudes and behaviors of the nurses regarding the safety reporting system are inadequate or have problems. Authority managers should take care of this issue, organize short-term reminder trainings other than the routine trainings related to the safety reporting system, make employees aware of the problems, produce solutions for the problems experienced in implementation and strive to reflect the trainings given to practice. In the study, 76.0% of the nurses stated that patient safety practices were adequate and 79.4% thought that quality programs contributed to their experience in Patient Safety, but the inadequate level of reporting suggests that patient safety culture has not developed sufficiently and that studies have to be done in this regard

Conclusions and Recommendations
In this study, 49.1% of the nurses stated that they were in the age range of 25-34, 90.9% of them were associate and bachelor graduates, 41.1% were 2-5 years in the institution, and 98.9% 90.9% of the respondents were satisfied that these trainings were adequate. In addition, 22.3% of the respondents indicated that they need education in this area. In the study, reporting on patient safety was reported at 78.3% and reporting of the highest falls was reported. It was determined that the rate of education in nurses who had less than one year of working time was low (p=0.038) and the rate of reporting of patient safety was significantly lower (p=0.049) in participants who had less than one year and more than 10 years of study time.

As a result;
¾ ¾ Despite the high rate of patient safety training, the low proportion of participants reporting in this regard in practice suggests that education is not always fully effective in changing attitudes.   ¾ ¾ We believe that the implementation of short-term reminder training may be beneficial.
As a result of the research findings; • Regular control tactics on patient safety experiences in institutions and evaluation of the current situation and the realization of the improvements in this way, • As a result of these evaluations, it is necessary to organize training programs and raise awareness of employees, • Emphasizing that in the trainings given for reporting on all aspects of patient safety, error reporting should not be regarded as punishment and should be regarded as an important part of the system, • In order to improve the patient safety experience in the institution, it is recommended that the patient safety culture should be placed in the institution first and the administrators should continue their beliefs and attitudes in this subject with determination.