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Abstract Background As the importance of a healthy work environment for nurses’ good practice and patient safety has been recognized, there is a need to assess nurses’ perceptions of the quality of a healthy work environment. Methods A conceptual framework and construct components were extracted through a literature review and in-depth interviews with shift nurses. The initial items of the instrument were developed according to the conceptual attributes, and the items were selected through content validity by ten experts. Two hundred and forty-seven shift nurses participated in this study through face-to-face surveys to test the reliability and validity of the instrument. The evaluation was used for item and confirmatory factor analyses to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from thirty-two nurses. Results The final instrument consisted of 23 items with five components identified through confirmatory factor analysis. Criterion-related validity was established using the K-PES-NWI (r = .54). Cronbach’s alpha for the total items was 0.85, and test-retest reliability was 0.73. Conclusion The quality of the healthy work environment instrument developed in this study was considered reliable and valid. The instrument developed in this study can be used to measure the quality of a healthy work environment as perceived by shift nurses and to identify preventive measures needed to improve the quality of the work environment.

IntroductionIn recent years, patient safety activities have shifted from being centered on healthcare providers to involving patients themselves. Health literacy of inpatients has a direct impact on patient participation behavior. Patient safety perception was also associated with willingness to participate in patient safety and patient participation behavior. Therefore, this study aimed to investigate the mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients.MethodsThis cross-sectional study was conducted to confirm the relationship between study variables. A total of 262 inpatients were recruited from patients admitted to the ward of a tertiary general hospital between October and November 2023. Participants were invited to complete self-reported questionnaires that measured health literacy, patient safety perception, willingness to participate in patient safety, patient participation behavior, and demographic information. Data were analyzed using a dual mediation model applying the PROCESS macro (Model 6) with 95% bias-corrected bootstrap confidence intervals.ResultsThis study analyzed the direct effects of health literacy on patient safety perceptions and patient participation behavior. Health literacy indirectly affected patient participation behavior through patient safety perceptions and willingness to participate in patient safety. Regarding the relationship between health literacy and patient participation behavior, patient safety perceptions and willingness to participate in patient safety showed a significant dual mediating effect.ConclusionsThis study identified the factors that promote patient participation behavior among inpatients. The mediating effect of patient safety perception on the relationship between health literacy and patient participation behavior was found to be strong. Building health literacy among inpatients ensures patient safety by increasing patient safety perceptions.