THE RELATIONSHIP BETWEEN DECISIONAL INVOLVEMENT AND SAFETY

ATTITUDES AMONG STAFF NURSES IN INTENSIVE CARE UNIT IN

A Thesis (Proposal) Presented to

In Partial Fulfilment
of the Requirement for the Degree
BACHELOR OF SCIENCE IN NURSING

Researchers:

(NAMES)

(NAMES)

(NAMES)

(NAMES)

Vivian Catherine C. Camano, RN, MAN

Research Adviser
 CHAPTER I

INTRODUCTION

Critical care nursing is a speciality that is responsible for providing high quality care

to critically ill patients and responding to life-threatening problems. Duties of an Intensive

Care Unit (ICU) nurse includes continuous monitoring of patients, coordinating care by the

health care team and discharge planning (Despins, Scott-Cawiezell & Rouder, 2010). With

the stressful environment and the physical structure of the ICU, nurses face challenges such

as high level of stress, high rate of errors and complications and high complexity care needed

by the patient. Aside from that, they should acquire knowledge, skills and experience to be

able to determine and arrange priorities of patient care needs and to maintain patient’s care,

hygiene and nutrition (Norris, Currie & Lecko, 2012). These aforementioned challenges

could compromise patient’s safety. This phenomenon has received an increasing attention

worldwide as managers and healthcare organizations spend great deal of efforts to enhance

quality and patient care safety by having non-punitive culture, supportive climate and

decisional involvement. Emphasis is placed on the system of care delivery that prevents

errors, learns from the errors that do occur, and is built on a culture of safety that involves

health care professionals and patients (Kear & Ulrich, 2015).

In the past, we have often viewed nurses’ responsibility in patient safety through the

narrow aspects of patient care such as avoiding medication errors and preventing patient falls.

In the Philippines, statistics show that about 18 percent of all reported hospital care-related

injuries is due to medication administration errors made by nurses and it can reach as high as

1.9 per patient per day (Dumo, 2012). While these dimensions of safety remain important

within the nursing purview, the breadth and depth of patient safety and quality improvement
are far greater. Among these unexplored factors is decisional involvement. Martin (2010)

noted that the quality of patient care is more affected by the degree to which they have an

active and central role in organizational decision making and by the degree to which the

hospital nurses are active and are empowered by the participants in making decisions about

their patient’s plan of care (Miller, Goddard & Laschinger, 2010). This integrative function is

said to promote professional nursing practice and uphold a powerful nursing executive thus

leading to superior patient care. In spite of this, recent studies revealed that nurses’ decisional

involvement is still restricted to the area of the nurse practice environment besides; nurses’

contribution in healthcare policy development is said to have been limited to implementation

(Shariff, 2015). Also, the level of nurses’ desire to and the scope of their participation in

decision making were not revealed yet (Liu, 2015; Warshawsky & Havens, 2010).

This could be the most critical contribution of nursing to patient safety especially

when nursing is continuously being redefined which would deliberately require a greater

autonomy and participation from nurses. But with its limited researches against the topic, the

researchers found it as an imperative to describe the relationship between the decisional

involvement and safety attitudes of intensive care unit nurses in selected hospitals in Manila.

The said combination of variables is deemed to produce more detailed information regarding

the said topic of concern, thereby contributing to the structure of long- term strategy to

improve the culture of the work environment and patient safety.

STATEMENT OF THE PROBLEM

The study aims to describe the relationship between the decisional involvement and

safety attitudes of intensive care unit nurses in selected hospitals in Manila.

Specifically, it seeks to answer the following questions:

1. What are the nurses’ actual decisional involvement in terms of:

1.2 Quality of Professional Practice

1.3 Professional Recruitment

1.4 Unit Governance and Leadership

1.5 Quality of Support Staff Practice

1.6 Collaboration / Liaison Activities?

2. What are the nurses’ safety attitudes in terms of:

2.1 Teamwork Climate

2.2 Safety Climate

2.3 Job Satisfaction

2.4 Stress Recognition

2.5 Perceptions of Management

2.6 Working Conditions?

3. What is the nurse’s profile?

4. Is there a significant relationship between:

4.1 Nurse’s Profile to Decisional Involvement and Safety Attitudes

REAEARCH OBJECTIVES

Decisional involvement and patient safety issues pose a great burden worldwide.

However, there is still inadequate data on the burden of these in the Philippines to specifically

address institutional and national concerns through directed programs, policies, and

interventions. This current study aims to describe the decisional involvement and safety

attitudes among nurses in selected tertiary hospitals in Manila, Philippines.

Decisional Involvement Safety Attitudes

Figure 1.Paradigm of the Study

The researchers used the Donabedian health care quality model as their guide in the

study. According to Moore, et al. (2015), improvement in structure of a health care should

lead to an improvement in clinical process, hence, a better patient outcome. They classified

three categories that describe information from which inferences can be drawn about the

quality of care namely: Structure, Process and Outcome. Structure of a health care

organization consists of the platform in which care occurs. This includes the attributes of

material resources such as equipment, facilities and personnel. Process indicates what the

health care worker is giving and what the patient is receiving. It includes the patient’s

activities in seeking care and carrying it out as well as the practitioner’s activities in making a

diagnosis and recommending or implementing treatment. Outcome is the effects and changes

which we can see on the patient health status after receiving care. Improvement in the

patient’s knowledge and salutary changes in the patient’s behavior are included under a

broader definition of health status, and is so the degree of the patient’s satisfaction with care

(Carayon, 2010).
 Also, the researchers utilized Kanter’s structure power theory. It consists of six

dimensions: the structure of opportunity, the structure of support, the structure of resources,

the structure of information, formal power and informal power. According to Poudel, et al.

(2014), employees who have access to opportunity, information, support and resources are

empowered and have control over the conditions resulting in increased worker autonomy and

involvement in organizational decisions.

In the context of the study, the variables are decisional involvement and safety

attitudes which are represented by two boxes. It is shown that a solid arrow correlates the

independent variable to the dependent variable. Correlation between decisional involvement

and safety attitude is determined.

SCOPE AND DELIMITATIONS

The study will focus on the decisional involvement of Intensive Care Unit nurses

using the Decisional Involvement Scale by Havens & Vasey (2003) and safety attitudes using

the Safety Attitude Questionnaire (2006) by the Agency for Healthcare Research and Quality

(AHRQ). The study will be conducted in selected tertiary hospitals in Manila using simple

random sampling technique. The nurses who will be chosen are those who are currently

employed as an Intensive Care Unit nurse. The study will delimit the nurses who has not

signed the informed consent and whose questionnaires are not properly filled and completed.
SIGNIFICANCE OF THE STUDY

Patients. The respondents through this study will be able to benefit from the better

safety attitude from their nurses. Also, with a great decisional involvement from the health

care team, they would be more involved in their care pathway.

For the staff nurses. This study may help to guide proactive strategies to decrease

errors and incidents in the patient care and the staff‟s environment. Empowerment from their

part may also be achieved. This may lead to encouragement of employees to put more effort

into completing their assigned work tasks and engage to a greater extent in discretionary

behaviors such as helping support their colleagues and taking initiative.

Nursing Management. Through this study, government and private sectors will

acquire information about the accommodation they can provide for their employees, also this

will give them information and idea on the specific or modified needs of their employees.

Moreover, the organization will gain idea about their employees’ insights about decisional

involvement and safety attitudes.

Nursing Management. They will gain ideas on how to improve their healthcare plans

and benefits to cater the needs of their ill employees. Results may be used as a basis for

healthcare plans design for improved medication adherence and status which may help on

increasing the employees’ productivity.

Future researchers. Practitioners in the field and in other fields of research would be

able to know the additional knowledge that the study could add. They can also use our study

as a basis for their research.

In this part, the terms used in the study are discussed for better understanding and clarity

for the readers.

Decisional Involvement. It is the way of sharing decision making authority as well as

the activities that manage nursing practice policy and the practice environment.

Profile. It refers to the nurse’s age, gender and length of service in the Intensive Care

Unit.

Safety Attitudes. This refers to the six factors namely a) safety climate, b)teamwork

climate, c) job satisfaction, d) stress recognition, e) perceptions of management, f) working

conditions (Sexton. et. al., 2006).

REVIEW OF RELATED LITERATURE

Decisional Involvement

Decisional involvement is a complex collaboration between nursing and a hospital’s

leadership (Poudel, et al, 2014). Partnerships where nurses and management meet each other

half way are essential for decisional involvement to be successfully actualized. Warshawsky

& Havens (2010) recognize that a strong indicator of nursing excellence and positive

outcome is staff driven decision making. It is indicated that involvement in decision making

has been positively linked to improved job satisfaction, positive clinical patient outcomes,

increased recruitment, decreased absenteeism, increased retention and decreased turnover

(Scherb, et al., 2010; Shariff, 2014). The inability to be involved in decision making and thus

make an impact leads to poor job satisfaction and poor self-esteem.

Involvement of the nurses in decision making is acknowledged in a number of reports

and initiatives as one of the elements necessary to achieve improved working conditions. In

2003, the Institute of Medicine (IOM) published a report discussing the link between practice

environments and patient safety where it revealed that unsafe work and workplace design

contributed to medical errors. As a result, several recommendations were made to improve

the work environment of nurses including the involvement of “direct care nurses in

operational decision making and the design of work processes and work flow” and the

employment of management structures and processes that “engage workers in non-

hierarchical decision making and in the design of work processes and work flow” (IOM

2003).
 Literatures suggest that nurses must be empowered in order to achieve patient safety

and quality of care required in the current health environment and this can be achieved

through nurse decisional involvement. In summary, the effects of decisional involvement are

viewed overall as positive for the patient, nurses and the professional practice and work

environments.

The related studies regarding decisional involvement are very limited. One of these is

Laschinger, et al.’s (2009) quantitative study that identified that the nurses perceived that

they had low levels of actual decisional involvement and that there was a statistically

significant difference between the actual and preferred level of decisional involvement of the

nurses. Nurses were shown to prefer to have more decisional involvement than they actually

had. Another study by Scherb et al. (2010), using a descriptive correlational design, identified

that the level of actual decisional involvement for nurses was low and their level of preferred

decisional involvement remained low, not reaching the level of the mid-range score of shared

decision making. Managers in this study agreed that they preferred not having shared levels

of decisional involvement with the nurses

Another quantitative descriptive study conducted in Iran identified that the nurses

perceived themselves to have only somewhat actual decisional involvement but to have high

levels of preferred involvement (Al-Dweik, et al., 2015). Meanwhile, Wong, et al. (2010)

showed that senior nurse leaders in Canada are able to influence decisions throughout the

organization. In review, the empirical studies indicate that nurses generally perceive that they

have low actual decisional involvement and would prefer to have more decisional

involvement.

In summary, it has been identified that nurses who are empowered to have the

freedom to initiate and participate in the decision making processes, resulting in change
which ultimately impacts positively on themselves, their patients and the work environment,

are said to have decisional involvement.

Safety Attitudes

Intensive care nursing is described as a specialized nursing care for acute and

critically ill patients with manifest or potential failures of vital functions (Bondevik, et al,

2014). Intensive care and the speciality of intensive care nursing are considered as the result

of advances in medicine, medical technology and nursing over the last century. Experience

showed that the mortality reduced by gathering patients in different specialized units such as

with regard to respiratory and cardiovascular support throughout the 24-hour-period, where a

sufficient number of bedside nurses were observing, recognizing and compensating for a

failure of the patients’ vital functions (Mota, 2015). Intensive care nurses need the highest

level of professional knowledge and skills to ensure the quality and safety of patient care and

that “there should be congruence between the needs of the patient, and the skills, knowledge

and attributes of the nurse caring for the patient” (Martin, 2010).

With regard to patient safety in the ICU, research shows that incidents involving

critically ill patients regularly take place (Douma, 2015). Errors related to medication and

procedures in connection with lines, catheters, drains, artificial airways and medical

equipment are common (Flotta, et al, 2012; Parmelli, et al, 2011) White (2012) found that

most serious errors occurred during the ordering or execution of treatment, and that the main

causes were slips and lapses rather than rule- or knowledge-based mistakes. In addition to

breakdowns in team processes, stress and workload are associated with a greater risk of

incidents (Khater, et al., 2015).

In this thesis, the use of “patient safety culture” is based on The European Network for

Patient Safety, which defines the culture of safety as: “an integrated pattern of individual and

organizational behavior, based upon shared beliefs and values that continuously seeks to

minimize patient harm which may result from the process of care delivery” (EUNetPaS,

2010, p. 4). This definition differs from more neutral definitions, as it reflects a culture of

safety in which actions are taken to reduce risk or harm to the patients (EUNetPaS, 2010).

Sammer et al. (2010) identified the properties of a patient safety culture as: leadership,

teamwork, evidence-based practice, open communication, learning from mistakes, errors

recognized as system failures simultaneously holding individuals accountable for their

actions, and lastly, patient-centred care. According to Ginsburg, et al. (2014), teamwork,

communication and how to handle incidents are particularly important for patient safety in

the ICU.

Although there are limited published studies about safety culture in Philippine

hospitals and in terms of the impact of healthcare-related harm in the country, several efforts

to promote patient safety have been initiated since 2008. One such initiative is the National

Policy on Patient Safety (Department of Health, 2011) that mandates Continuous Quality

Improvement (CQI) patient safety programs in all healthcare facilities. These programs are

supported by various organizations with the Department of Health (DOH) through

Memorandum 2011-0160 designating a National Patient Safety Day. Healthcare

organizations dedicate this event to safe patient care activities. Most initiatives are done at

institutional levels during various local fora. However, these events were not documented

which would have been useful for benchmarking (Paguio, 2016).

Healthcare provider attitudes about organizational factors such as safety climate and

morale, work environment factors such as staffing levels and managerial support, team
factors such as teamwork and supervision, and staff factors such as overconfidence and being

overly self-assured are components of an organization's safety culture (Sexton et al., 2006).

One most commonly used instruments by researchers is the Safety Attitudes Questionnaire

(SAQ), used by some authors to measure patient safety culture (Devriendt et al., 2012) and

also to measure safety-related attitudes concerning teamwork climate, job satisfaction,

perceptions of management, safety climate, working conditions and stress recognition

(Sammer et al., 2010). Teamwork climate may be described as perceptions about the quality

of collaboration. Job satisfaction reflects the positive feelings towards work. Perceptions of

management involve issues such as the approval of managerial action. Safety climate reflects

the perceptions of a strong and proactive organizational commitment to safety. Working

conditions offers perceptions about the qualitative and supportive dimensions of the work

environment, and stress recognition gives confirmation of how the daily activity of workers is

influenced by stressors (Gordon, 2013).

Studies have demonstrated a variation in the perception of patient safety culture

among professions, both within ICUs in different hospitals (Hor, et al, 2013) and across ICUs

in a single institution (Khater, et al., 2015). In some studies, a more negative perception of

patient safety culture was identified among intensive care nurses compared to physicians

(Sexton et al., 2006), while another study found no differences between the professions (Reid

& Bromiley, 2012). The perception of a positive patient safety culture has been reported to be

associated with fewer patient safety incidents Nonetheless, incident reporting has been

documented as an area for improvement Management and a strong and proactive

organizational commitment to safety in ICUs are identified to be associated with patient

outcomes (Dumo, 2012)

In addition, in a survey by Bondevik, et al. (2014) measuring safety attitudes, less

than half of all nurses attained positive stress recognition scores (positive scores indicate a
greater acknowledgement of the effects of stress). Nearly half of nurses (45%) in the study

had significantly higher stress recognition scores (20%) and only 45% nurses were satisfied

with their jobs. Also, nurses had low perceptions of their working conditions but favourable

teamwork climate scores.

In the contrary, some studies have demonstrated that ICU nurses have positive

perceptions of teamwork within the unit (Baid & Hargreaves, 2015; Baartman & de Bruijn,

2011). However, while the ICU nurses generally have a positive perception of teamwork, a

paradox is that failures are found in ongoing team performance, with coordination, leadership

and communication all being contributory factors to patient safety incidents in the ICU (El-

Sayed, et al., 2010; Poley, et al., 2011).

On the other hand, Li (2013) found that safety attitudes of nurses were positive,

although some safety attitude areas were self-evaluated as lower such as Job satisfaction,

Teamwork climate, Communication openness and Hospital handoffs and transitions.

Attitudes have been found to be more positive after training, and similar to the improvements

of knowledge reported by Ahmed et al., (2013), the same study showed that after a day

training course on patient safety, nurses’ safety attitudes had significantly improved post

course and were sustained based on their own evaluations.

A study by Paguio (2016) was conducted to identify the safety attitudes among

Filipino nurses. Nurses from the National University Hospital displayed both positive Safety

Culture and Safety Attitudes based on AHRQ-HSOPS and SAQ. Dimensions that garnered

the highest positive perceptions in Safety Culture were Organizational Learning and

Teamwork while the lowest were Hospital Handoffs and Non-Punitive Response to Error. On

the other hand, dimensions on Safety Awareness that received the highest positive

perceptions were Teamwork and Safety Climate while the lowest was Stress Recognition.
Perceptions of nurses also varied significantly across ranks in position titles and work

settings. This implicates that there are identifiable dimensions that can be improved in both

Safety Culture and Safety Attitude that can have a positive impact on nurses and potentially

impact nurse-patient and hospital-sensitive outcomes through hospital-wide improvement

programs.

An understanding of nurses’ perceptions and expectations regarding patient safety is

essential for the implementation of appropriate strategies to manage nursing care. In this

sense, registered nurses’ beliefs and values as part of the organizational culture are important

aspects to be considered (Despins, et al., 2010).

Synthesis

Intensive care with its complexity represents potential patient safety challenges for

critically ill patients. Human errors are stated as the most common cause of patient safety

incidents, with failures in team performance as contributory factors.

Most of the studies are international studies and very limited are done in the

Philippines. This leads us to conclude that a lack of research studies was done concerning the

subject in the country. One also sees that the previous studies applied to various medical

departments and are mainly concerned with patient safety culture alone or safety attitudes.

This differs from this study because the researchers are going to correlate it with decisional

involvement and the target group is the Intensive Care Unit nurses.

Based on the literature review, it can be concluded that it is a big challenge for health

care professionals to ensure patient safety in complex health care systems. Therefore, this
research is an endeavour to identify the relationship between safety attitude and decisional

involvement for the improvement of safety culture.

HYPOTHESES

The following are the null hypotheses of the study:

1. There is no significant relationship between the respondents’ profile to decisional

involvement and safety attitudes.

RESEARCH METHODOLOGY

RESEARCH DESIGN

The researchers will employ a cross-sectional research design. Specifically,

descriptive and correlational designs will discuss extensively the nurses’ decisional

involvement and safety attitude. The descriptive approach will be used to determine the

profile of the nurses, their decisional involvement and safety attitudes. Descriptive design

simply will be to describe the variables of the study. Lastly, correlational design will be used

to correlate the two factors: decisional involvement and safety attitudes. This type of design

will ascertain whether an increase or decrease in one variable corresponds in the increase or

decrease of the other variable, however, this did not imply the causation of the correlates to

empathy of the nurses.

SAMPLE AND SAMPLING TECHNIQUE

The respondents of the study are the employed Intensive Care Unit nurses of the

tertiary hospitals in Manila. The respondents will be chosen regardless of their position at the

ICU and he/she should have signed the informed consent.

Accidental sampling which is under non-probability sampling will be employed in

this study. The researchers will present their letter of permission to the chief nurses of the

selected hospitals and will be asked if the charge nurse can distribute it among the nurses.

The researchers will acquire the total number of nurses who meets the criteria from the chief

nurse to know the sample size.

The researchers will conduct the study at the selected tertiary hospitals in Manila. A

list of the tertiary hospitals will be acquired from the Department of Health and from the list,

simple random sampling – fishbowl technique will be used

RESEARCH INSTRUMENTS

There were three (3) kinds of instruments used in this research. It includes:

DEMOGRAPHIC PROFILE QUESTIONNAIRE

The researchers included the identification of age, gender and length of service in the

questionnaire.

DECISIONAL INVOLVMENT SCALE

The researchers also used Decisional Involvement Scale by Havens & Vasey (2003).

This scale, consisting of 21 items, measures actual and/or preferred decisional involvement

for staff nurses and managers on a nursing unit. Sample items include determining the unit

schedule, selecting unit leadership, and selecting staff for hire. The DIS uses a five-point

scale to indicate the degree to which decisions are the responsibility of staff nurses and

administration/ management on the nursing unit. Exploratory and confirmatory factor

analyses (contact corresponding author for information) showed that the DIS measures nurse

involvement in decisions and activities related to six constructs: unit staffing, quality of

professional practice, professional recruitment, unit governance and leadership, quality of

support staff practice, and collaboration/liaison activities. Reliability of the DIS has been
assessed through determination of Cronbach’s alpha following numerous administrations to

staff RNs and nurse managers. Consistently, the instrument has demonstrated total scale

alphas ranging from .91 to .95, which indicates a highly reliable measure.

For each of the 21 items, respondents indicate which nursing group (staff nurses or

administration/management) that they perceive has the primary responsibility for the decision

or activity (actual decisional involvement) or that they would prefer have the responsibility

for the decision or activity (preferred decisional involvement) on the unit on which they

work. Response choices are as follows: (1) administration/ management only, (2) primarily

administration/ management with some staff nurse input, (3) equally shared by

administration/management and staff nurses, (4) primarily staff nurses with some

administration/ management input and (5) staff nurses only. Items can be considered

individually, by the six subscales, or by total DIS scale. A high score suggests a high degree

of staff RN involvement, a low score suggests a low degree of staff RN involvement, and a

midrange score suggests a state of sharing of decision-making between

administration/management and staff RNs.

SAFETY ATTITUDE QUESTIONNAIRE

The researchers used a survey tool named “Safety Attitudes Questionnaire” (SAQ), a

psychometrically sound instrument for assessing six safety-related climate domains by

systematically eliciting input from the respondents. It is a refinement of the Intensive care

Unit Management Attitudes Questionnaire, which was derived from a questionnaire widely

used in commercial aviation, the Flight Management Attitude Questionnaire (FMAQ). It was

developed by Bryan Sexton, Eric Thomas, and Bob Helmreich with funding from the Robert
Wood Johnson Foundation and Agency for Healthcare Research and Quality. The “Safety

Attitudes Questionnaire” is a single page questionnaire with 36 items and demographics

information (length of service). Each of the 36 items is answered using a Five-point Likert or

Summated Rating Scale (A as Disagree Strongly, B as Disagree Slightly, C as Neutral, D as

Agree Slightly, E as Agree Strongly). Some items are negatively worded. It has a scale

reliability of 0.9 in the Raykov’s coefficient while it scored .89 for the Cronbach alpha. A six

factor model of provider attitudes fit to the data at both the clinical area and respondent

nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate,

Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition.

The SAQ can be used to meet the increasing demand for safety climate (often called safety

culture) assessment at the clinical area level. It is also used in other studies in order to have a

baseline data about the existing culture of the health care providers. Responses to each item

in a scale is summed and divided by the number of items in that scale to create that range

from 0 to 100. The scores obtained will represent individual perceptions with higher scores

reflecting more favorable perceptions of the item.

Essential data needed for the study will be gathered through the setting of guiding

principles which will allow the researchers to acquire them. The following steps will be

undertaken in obtaining and collecting data.

The initial step that the researchers will do is to get permissions from the chosen

hospital from which the targeted participants will come from. This will be done through the

dissemination of communication letters. Letters of consent that will include the purpose of

conducting the study, the steps in data gathering, and the criteria of the respondents will be

accomplished by the researchers. The thesis adviser, level coordinator, and the dean will also

sign the letters that will be disseminated to the respondents.

The researchers asked the permission of the respective authors and/or developers of

the questionnaires Decisional Involvement Scale and Safety Attitude Questionnair. Their

scoring system for proper presentation of results was also inquired. As soon as permission

will be granted from the targeted institutions, the researchers will begin their actual data

gathering. The respondent should have read and signed the informed consent attached to the

questionnaire. Once they have completed the questionnaires, they will be collected and

encoded for tabulation and analysis of data. After the researchers arranged, tabulated and

tallied the data, analysis and interpretation will be done. Appropriate statistics will be used

along with the software for proper calculations to either accept or reject the null hypothesis

presented.

STATISTICAL DATA

Statistical Package for the Social Sciences (SPSS) will be used for proper calculations

to either accept or reject the null hypothesis presented.

The descriptive statistics will be used for the numerical descriptions of the variables

of the study. It consists of a table containing the categories and their frequency of occurrence.

The percentage will be used to identify the weight of frequency in reference to the total

number of responses. In the study, it will be applied to describe the demographic profile of

the nurses (age, gender and length of service), their decisional involvement and safety

attitudes.

INFERENTIAL STATISTICS

Pearson R Correlation

Pearson R will be used to measure the correlation between two interval/ratio variables

(decisional involvement and safety attitudes.). A p-value of less than 0.05 level of

significance rejects the null hypothesis, then the results would be significant because it is

more stringent than 0.05 while, a p-value of more than 0.05 accepts the null hypothesis, it

indicates a non-significant relationship (Creswell & Clark, 2011).

ETHICAL CONSIDERATIONS

As to ethical considerations, informed consent will be attached to each questionnaire

which will verify their permission and assure them that their identity would be held in utmost

confidentiality.