Received: 18 March 2019 Revised: 22 April 2019 Accepted: 23 April 2019

DOI: 10.1111/jep.13174

ORIGINAL PAPER

Effects of electronic medical records on patient safety culture:

The perspective of nurses

Özlem Özer PhD1 | Fatih Şantaş PhD2

1
Faculty of Economics and Administrative
Sciences, Department of Healthcare
Management, Burdur Mehmet Akif Ersoy
University, Burdur, Turkey
2
Faculty of Economics and Administrative
Sciences, Department of Healthcare
Management, Yozgat Bozok University,
Yozgat, Turkey
Correspondence
Özlem Özer, Burdur Mehmet Akif Ersoy
University, Faculty of Economics and
Administrative Sciences, Department of
Healthcare Management, Burdur, Turkey.
Email: oozer@mehmetakif.edu.tr
Abstract
Objectives: This study investigates the effects of nurses' views regarding electronic
medical records on patient safety culture.
Methods: The implementation part of the study was conducted with nurses work-
ing in seven state hospitals in the Burdur province of Turkey. The data were collected
between 15 March and 20 April 2018. Correlation and multiple regression analyses
were performed to evaluate the relationships among the variables in the study. In
addition, descriptive analyses (mean, standard deviation) and Cronbach α coefficients
of reliability of the scales were also used.
Results: The results of the analyses revealed that control variables (gender, educa-
tional level, age, etc) and all dimensions of electronic medical records affected all
three dimensions of patient safety culture. The control variables and all dimensions
of electronic medical records explained 41% of the total variance in perceptions of
process, 42.5% of the total variance in management support for patient safety, and
27.9% of the total variance in perceptions of safety.
Discussion: This study provides insight concerning the effects of nurses' views of
electronic medical records on patient safety culture. The results of the study reveal
that nurses' views of electronic medical records affect the perception of patient
safety culture positively.
Conclusions: It is recommended that further studies be conducted on topics such
as the use of medical records and the development of patient safety. Health care
managers should encourage nurses to undergo training and educational efforts on
electronic medical records and patient safety.

K E Y W OR D S

electronic medical records, patient safety culture, health sector

1 | I N T RO D U CT I O N the most comprehensive capabilities. Therefore, they have great

Information technology has been used as an important tool for
improving patient safety and quality of care, especially in promoting
the practice of evidence‐based medicine. Among all health information
technologies in current use, electronic medical records (EMRs) have
potential in increasing the quality of health care.1 EMRs are computer-
ized records of clinical, demographic, and management information in
health care organizations, especially hospitals.2 By another definition,
EMRs constitute a computerized medical information system that col-
lects, stores, and displays patient information.3 In addition, EMRs also

J Eval Clin Pract. 2019;1–7. wileyonlinelibrary.com/journal/jep © 2019 John Wiley & Sons, Ltd. 1
2 ÖZER AND ŞANTAŞ
allow for recording clinical data electronically, making decisions, plac-
ing and receiving orders, making requests to the pharmacy, recording
X‐ray and laboratory findings, and documenting clinical activities.4
EMR systems have the potential to provide significant benefits for
physicians, clinical applications, and health care organizations.5 The
expected benefits of EMRs are to provide medical histories without
paper, reduce health care costs, allow stakeholders to deliver the right
treatment at the right time, promote the practice of evidence‐based
medicine, build effective medical practices, provide convenience in
maintaining the health information of patients, and provide faster
searches and updates.6
The culture of patient safety, which is another variable examined in
the present study, is defined as the perception of the necessity of
values, attitudes, skills, and behaviours focusing on an institution's
patient care processes and the related workforce.7 By another defini-
tion, patient safety culture is defined as the units, organizational struc-
tures, and systems that together produce shared values of important
issues among the members of an organization, beliefs about how
issues in the organization are being addressed, and behavioral norms
in the organization that contribute to patient safety and interactions.8
The aim of patient safety is to create an environment that will have
positive physical and psychological effects on patients and their rela-
tives and hospital workers. The basic goal in this effort is to set up a
system that will hamper any error in the delivery of service and pro-
9
tect patients from any error, eliminating any possibilities of error.
Despite EMR systems being utilized in many hospitals and health
care providers benefiting from the effective and efficient data pro-
cessing, their role has received little attention from nurses who pro-
vide 24‐hour patient care.10 As stated above, however, EMRs
substantially support and facilitate the daily work of health care staff
and nurses through electronic data processes. With EMR systems,
nurses write nursing care plans, record basic findings of patients, mon-
itor patient laboratory results, and perform many medical record func-
tions related to patient care.11 Nurses in all hospitals play a vital role in
ensuring patient safety due to the nature of their work involving
patient monitoring and coordination of care. The nature of the work
carried out by nurses offers them various opportunities with regard
to reducing adverse events and preventing errors prior to their
occurrence.12,13
It is thought that the views of nurses who utilize medical records
regarding examination of a patient's problems, control of medical
information, access to other required information, and provision of
sufficient information from the system have an impact on patient
11
safety culture. In a study by Top and Gider , it was determined that
nurses were satisfied with the use of medical records, testifying that
EMR systems improved patient safety, that the system was useful
for them, and that the system was necessary and good for the hospi-
tal. In this context, it is considered that the evaluation of the views of
nurses, who constitute an important professional group in health insti-
tutions, on the use of EMRs and patient safety culture is crucial.
Finally, e‐transformation programmes are in use as a subpart of the
central government's health reform programme in Turkey. Thanks to
this application, a rapid transformation in the EMR system in Turkey
has been provided. The hospitals included in the present study are
hospitals that have been involved in this transformation.
The aim of this study is to investigate the effects of nurses' views
regarding EMRs on patient safety culture. The following hypotheses
were established in accordance with this purpose.
Hypothesis 1. The views of nurses with regards to all
dimensions (use, quality, and user satisfaction with EMR
systems) of EMRs have a statistical relationship with
the process subdimension of patient safety culture.
Hypothesis 2. The views of nurses with regards to all
dimensions (use, quality, and user satisfaction with EMR
systems) of EMRs have a statistical relationship with
the management support for patient safety.
Hypothesis 3. The views of nurses with regards to all
dimensions (use, quality, and user satisfaction with EMR
systems) of EMRs have a statistical relationship with per-
ceptions of safety.
2 | METHODS
2.1 | Sampling
The sample space surveyed in this study consists of all nurses (N =
645) working in seven state hospitals in Burdur province, Turkey.
The sample space was all the nurses working in those hospitals. There
was no difference between nurses who responded to the survey and
those who chose not to participate. A questionnaire paper was used
to collect data from all nurses who agreed to participate in the study,
and 398 nurses responded to the study tools. The data collection
period was 15 March to 20 April 2018.
2.2 | Data collection method
The Use, Quality, and User Satisfaction with EMR Systems Question-
naire, developed by Otieno et al10 and adapted to Turkish by Top
et al2, was used in this study. This questionnaire is used to measure
the views of nurses with regards to all dimensions of EMRs and to look
for relationships between all dimensions of EMRs and all dimensions of
patient safety culture (ie, perceptions of safety, management support
for safety, and process). The questionnaire paper consists of 40 items
categorized into three subdimensions as follows: 15 items assessing
“use of EMRs,” defined as the frequency of the use of EMRs in complet-
ing patient care‐related tasks (eg, documenting physical assessment of
patients); 13 items assessing “quality of EMRs,” defined as evaluation
of the quality of the EMR system, its outputs, and its responsiveness
(eg, degree of EMR system providing the precise information needed);
and 12 items assessing “user satisfaction with EMRs,” defined as the
extent to which nurses believe that the EMR system is important in
improving their work (eg, degree of nurses' performance improvement
due to the EMR system). Answers are scored using a 5‐point Likert
ÖZER AND ŞANTAŞ 3

scale. The items included in the dimensions of use and quality are eval-
uated from 1 = “never/almost never” to 5 = “always/almost always,”
and the expressions included for user satisfaction are evaluated from
1 = “not at all” to 5 = “very great.” In this study, the Cronbach α reliabil-
ity coefficient of the EMR scale was found to be 0.941. The reliability
coefficients for the subdimensions of the scale, which are use of EMRs
(0.87), quality of EMRs (0.90), and user satisfaction with EMRs (0.87),
were calculated as higher than 0.85.
The Patient Safety Culture Questionnaire developed by Çelen
et al14 was also used to measure perceptions of patient safety
culture. This questionnaire paper consists of 14 items and three
subdimensions. There are eight items for the process dimension
(eg, in this unit, a formal process is followed to report problems related
to patient safety), four items for management support for patient
safety (eg, hospital management attaches great importance to risk
factors associated with patient care), and two items for perception of
safety (eg, if a mistake is made that causes significant consequences,
notification will be given to the relevant authorities). Answers are
scored using a 5‐point Likert scale (1 = “strongly disagree,” 5 =
“strongly agree”). In this study, the Cronbach α reliability coefficient
of the patient safety culture scale was found to be 0.914. The reliabil-
ity coefficients for the subdimensions of the scale, which are process
(0.88), management support for patient safety (0.79), and perception
of safety (0.75), were calculated to be higher than 0.74.
2.3 | Data analysis
All statistical analyses were performed using SPSS 20.0. Descriptive
analyses, reliability analysis, correlation analysis, and multiple analysis
were used. In the regression analysis, qualitative variables (gender,
educational level, age, etc) were incorporated into the model by desig-
nating them as dummy variables. Regression analyses were performed
in two stages. In the first stage, (first model) the control variables and
in the second stage (second model) control variables and the
subdimensions of EMRs (use, quality, user satisfaction) were included
to the model. In the regression analysis, independent variables were
demographic variables such as age and gender for the first model,
while they were demographic variables such as age and gender as well
as the three dimensions of EMRs (use, quality, and user satisfaction)
for the second model. Dependent variables were process, manage-
ment support, and perceptions of safety in these models.
3 | RESULTS
Table S1 shows that 52.5% of the nurses are 32 years old or above;
71.4% of them are female and 44.8% have an undergraduate or post-
graduate educational level. 51.5% of the participants have been in the
health sector for 10 years or more, while 75.9% of the nurses have
had computer training and 62.1% of them have been using computers
for 10 years or more.
Table 1 presents descriptive statistical values and correlation anal-
ysis results for all subdimensions of EMRs and patient safety culture.
While “quality” has the highest mean score (3.55 ± 0.71) among the
subdimensions of EMRs, the perceptions of safety subdimension has
the highest mean score (3.70 ± 0.95) among the subdimensions of
patient safety culture. The correlation analysis reveals a significant
correlation between the use and quality of EMR systems (r = 0.689;
P < .001), the use of and user satisfaction with EMR systems (r =
0.523; P < .001), and the quality of and user satisfaction with EMR
systems (r = 0.616; P < .001). The data show that the highest correla-
tion is between use and quality scores for EMRs. Correlation analysis
also reveals a significant correlation between the scores for process
and management support for patient safety (r = 0.673; P < .001), for
process and perception of safety (r = 0.685; P < .001), and for manage-
ment support for patient safety and perceptions of safety (r = 0.507;
P < .001). The data show that the highest correlation is between
process and perceptions of safety for patient safety culture.
The correlations between all dimensions of EMRs and all dimensions
of patient safety culture (0.421 ≤ r ≤ 0.589) are statistically significant
in the same direction and at a medium level. All subdimensions are
positively correlated (P < .001) with each other.
The regression models for the effects of all EMR subdimensions on
the level of patient safety culture (process, management support for
patient safety, and perception of safety) are presented in Tables 2, 3,
and 4. In the multiple regression models created, the Durbin‐Watson
coefficients are less than 2.5 and the variance inflation factors (VIFs)
are less than 10, which indicates that there are no autocorrelation or
multicollinearity problems.15 In line with this, it can be said that there
are no autocorrelation or multicollinearity problems in the regression
models given in Tables 2, 3, and 4.
In Table 2, the results of regression analysis for the effects of all
EMR subdimensions on process, which is one of the dimensions of
patient safety culture, are given. While control variables are seen

TABLE 1 Descriptive statistics and intercorrelations between research variables

Variables Mean SD Use Quality User Satisfaction Process Management Support Perceptions of Safety

Use 3.44 0.71 (1)

Quality 3.55 0.71 0.689** (1)
User satisfaction 3.33 0.75 0.523** 0.616** (1)
Process 3.56 0.84 0.505** 0.540** 0.561** (1)
Management support 3.58 0.86 0.528** 0.589** 0.534** 0.673** (1)
Perceptions of safety 3.70 0.95 0.421** 0.427** 0.457** 0.685** 0.507** (1)

**Correlation is significant 0.01 (two‐tailed).

4 ÖZER AND ŞANTAŞ

TABLE 2 Results of regression analysis on the effects of all subdimensions of electronic medical record on process

Model 1 Model 2

Variables β t VIF β t VIF

Age (≥32) −0.084 −1.158 2.149 0.005 0.087 2.178

Gender (male) −0.078 −1.560 1.021 0.003 0.074 1.041
Educational level (associate) −0.021 −0.320 1.821 −0.012 −0.228 1.826
Educational level (undergraduate or postgraduate) −0.136 −2.050** 1.770 −0.052 −0.985 1.794
Total working time in health sector (≥10 y) 0.151 1.990** 2.321 0.081 1.345 2.353
Computer traning (yes) 0.012 0.231 1.037 −0.046 −1.114 1.069
Computer usage time (≥10 y) −0.023 −0.414 1.205 −0.089 −2.054** 1.219
Use (x) (x) (x) 0.195 3.545* 1.995
Quality (x) (x) (x) 0.198 3.308* 2.346
User satisfaction (x) (x) (x) 0.338 6.590* 1.723
Regression summary R = 0.191 R = 0.640
R2 = 0.036 R2 = 0.410
F = 2.103** F = 26.897**
Durbin‐Watson = 2.128 Durbin‐Watson = 2.246

Abbreviations: VIF, variance ınflation factor; (x), not in the equation.*P < .01.**P < .05.

TABLE 3 Results of regression analysis on the effects of all subdimensions of electronic medical record on management support for patient
safety

Model 1 Model 2

Variables β t VIF β t VIF

Age (≥32) −0.059 −0.802 2.149 0.031 0.541 2.178

Gender (male) −0.051 −1.021 1.021 0.030 0.762 1.041
Educational level (associate) −0.008 −0.124 1.821 −0.001 −0.011 1.826
Educational level −0.130 −1.956 1.770 −0.046 −0.887 1.794
(undergraduate or postgraduate)
Total working time in health sector (≥10 y) 0.136 1.788 2.321 0.068 1.151 2.353
Computer traning (yes) 0.024 0.471 1.037 −0.022 −0.554 1.069
Computer usage time (≥10 y) 0.007 0.137 1.205 −0.064 −1.512 1.219
Use (x) (x) (x) 0.195 3.579* 1.995
Quality (x) (x) (x) 0.306 5.185* 2.346
User satisfaction (x) (x) (x) 0.244 4.822* 1.723
Regression summary R = 0.178 R = 0.652
R2 = 0.032 R2 = 0.425
F = 1.814 F = 28592*
Durbin‐Watson = 2.010 Durbin‐Watson = 1.986

Abbreviations: VIF, variance ınflation factor; (x), not in the equation.*P < .01.**P < .05.

in the first model, in the second model, the impact of control vari-
ables and the EMR subdimensions (use, quality, user satisfaction)
on process are seen. While control variables explain 3.6% of the
total variance in the model, after including all EMR subdimensions
in the model, the variance increases to 41%. According to the stan-
dardized regression coefficient (β), the relative order of importance
of the independent variables on process has user satisfaction with
EMRs ranking first (β = 0.338), followed by the quality of EMRs (β
= 0.198) and the use of EMRs (β = 0.195). This finding confirms
Hypothesis 1.
In Table 3, the regression analysis results for the effects of all EMR
subdimensions on management support for patient safety, which is
one of the aspects of patient safety culture, are given. It is seen that
management support for patient safety for all dimensions of EMRs
increases the R2 value from 3.2% to 42.5%. In other words, while
control variables explain 3.2% of the total variance in the model, after
including all EMR subdimensions in the model, the explained total
variance rises to 42.5%. According to the standardized regression coef-
ficient (β), the relative order of importance of the independent variables
on management support for patient safety has quality of EMRs ranking
ÖZER AND ŞANTAŞ 5

TABLE 4 Results of regression analysis on the effects of all subdimensions of electronic medical record on perceptions of safety

Model 1 Model 2

Variables β t VIF β t VIF

Age (≥32) −0.059 −0.807 2.149 0.013 0.204 2.178

Gender (male) −0.015 −0.300 1.021 0.054 1.221 1.041
Educational level (associate) 0.053 0.781 1.821 0.063 1.077 1.826
Educational level (undergraduate or postgraduate) −0.057 −0.854 1.770 0.015 0.257 1.794
Total working time in health sector (≥10 y) 0.090 1.173 2.321 0.034 0.516 2.353
Computer traning (yes) 0.021 0.417 1.037 −0.030 −0.668 1.069
Computer usage time (≥10 y) −0.072 −1.301 1.205 −0.126 −2.642* 1.219
Use (x) (x) (x) 0.199 3.267* 1.995
Quality (x) (x) (x) 0.125 1.986** 2.346
User satisfaction (x) (x) (x) 0.286 5.045 1.723
Regression summary R = 0.144 R = 0.529
R2 = 0.021 R2 = 0.279
F = 1.173 F = 15.005*
Durbin‐Watson = 1.832 Durbin‐Watson = 1.860

Abbreviations: VIF, variance ınflation factor; (x), not in the equation.*P < .01.**P < .05.

first (β = 0.306), followed by user satisfaction with EMRs (β = 0.244) and
the use of EMRs (β = 0.195). These results show that the second
hypothesis of this study, Hypothesis 2, has been confirmed.
In Table 4, the regression analysis results for the effects of all EMR
subdimensions on perceptions of safety, which is one of the aspects of
patient safety culture, are given. While control variables explain 2.1%
2
of the total variance in the model (R = 0.021), after including all EMR
subdimensions in the model, the explained total variance rises to
27.9%. According to the standardized regression coefficient (β),
the relative order of importance of the independent variables on
the perceptions of safety has user satisfaction with EMRs ranking
first (β = 0.286), followed by the use of EMRs (β = 0.199) and the
quality of EMRs (β = 0.125). These results show that the third
hypothesis of this study, Hypothesis 3, has been confirmed.
4 | DISCUSSION
EMRs are intended to support clinical activity, improve efficiency, and
reduce errors.16 The primary goal of EMR systems is to reduce medical
errors and also to report new types of errors that are directly related to
EMRs.17 The use of EMRs in the health care system offers a number of
advantages as it can improve the quality of patient care, decrease
health care costs, ensure adherence to government regulations and
the standards of accrediting agencies, and improve the accessibility
and delivery of health care.4 EMR systems have a potential effect in
the improvement of patient safety and quality of care, and they can
support better nursing care through automatic warnings, guidelines,
and standardized care plans.18,19 Nurses are one of the most important
and largest health care team groups providing direct health care ser-
vices to patients, determining the needs of patients, and determining
the use of required medical care, equipment, and materials. That is
why nurses are one of the most important users of EMR systems, which
transfer health care data to the electronic environment.20
Due to the limited number of studies in the literature that examine
the views of nurses on both EMRs and patient safety culture, more
studies are needed in this field. In line with this aim, the main purpose
of this study was to examine the effects of nurses' views of EMRs on
patient safety culture. In order to evaluate this purpose, regression
analyses were carried out on the research data. According to the
regression model created, the control variables and all dimensions of
EMRs affect all three dimensions of patient safety culture. The control
variables and all dimensions of EMRs explain 41% of the total variance
in perceptions of process, 42.5% of the total variance in management
support for patient safety, and 27.9% of the total variance in percep-
tions of safety. Accordingly, an increasing level of nurses viewing
EMRs positively statistically increases their perceptions of patient
safety culture. In a study performed by Çakırlar in 2016, 57.5% of
nurses stated that the use of electronic health/patient records
increased the safety of patient care; 27.3% stated that there was no
significant relationship between the use of electronic health/patient
records and patient safety.21 In the study performed by Moody et al,
it was found that the majority of nurses accepted that electronic
health records increased the quality of patient care, allowed for better
nursing documentation, and considerably enhanced care and patient
safety.22,23 In the study carried out by Tubaishat, nurses' experiences
were not found to be a significant predictor for any of the
subdimensions of EMRs. Age, however, was a significant predictor
for use of electronic health records. In addition, Tubaishat found that
the user's sex was a predictor for satisfaction with electronic health
records, but not for the use or quality of the system.24
In this study, the correlation analysis showed a significant
relationship among all subdimensions. Accordingly, increases in all
subdimensions of EMRs and patient safety culture caused mutual
6 ÖZER AND ŞANTAŞ
increases in each other. In the study performed by Tubaishat, a
high level of quality was associated with a high level of use of and
satisfaction with EMRs, and a correlation was also found to exist
24
between use and satisfaction. In the study carried out by Top and
Gider, significant correlations were found among use, quality and user
satisfaction scores, and they determined that the highest correlation
was between quality and user satisfaction scores for EMR systems.25
Likewise, in the study carried out by Eriş, it was found that the rela-
tionship between quality and satisfaction was high.20
It was determined in the course of this study that nurses' views of
EMRs were at a medium level, and the dimension for which their views
of EMRs were at the highest level was the dimension of the quality of
EMRs. When the opinions of the nurses regarding the quality of med-
ical record systems are examined, the main topics concerning them are
whether the system provides timely accessibility to the information
required, and the availability of current information in the system. It
was reported by Top and Gider in 2012 that nurses' use of EMRs
was at a low level (1.96), while their opinions on EMRs in respect to
quality (3.16) and satisfaction (3.28) were at medium levels.25 It was
found in the study performed by Tubaishat in 2017 that Jordanian
nurses held positive views on how the systems are used and the qual-
ity of the systems, and they demonstrated high levels of satisfaction
with EMRs.24 It was found in the study performed by Cinaroglu and
Avcı in 2015 regarding internal diseases and surgical nurses that the
general average views of nurses on the use of electronic health records
were scored as 1.39.26 In the study carried out by Eriş, the score of
nurses for the use of EMRs and the assessment score of nurses for
the quality of EMRs were found as 3.59, and their user satisfaction
level for EMRs was found as 3.23.20 Asiri et al reported that nurses
had positive attitudes regarding the use of EMRs and thought that
EMRs were useful in supporting clinical practices.27 Likourezos et al,
who investigated the level of satisfaction of health professionals
regarding an EMR system, further concluded that clinicians found the
use of EMRs to be easy and reported satisfaction from the impact of
EMRs on their work.16 It was stated in the study carried out by Alharthi
et al that 40% of physicians were satisfied with the EMR system.28
The patient safety culture of respondents in this study was also
determined to be at a medium level. While the dimension of perception
of safety had the highest mean among the dimensions of patient safety
culture, it was followed by “management support for patient safety” and
“process.” In the study performed by Gündoğdu and Bahçecik, it was
determined that the nurses' score of general perception of safety was
at a medium level.29 In the study performed by Çelen et al, while nearly
all employees (82.2%) had a positive “perception of safety” and most of
them (64.4%) approved of the “process” of patient safety in their units,
the percentage of those who approved of the “management support for
patient safety” for the perception of safety (57.8%) was lower in com-
parison with other dimensions.14 While the general perception of safety
was determined at a rate of 42% and the management support for
patient safety was approved by 26% in the study performed by Al‐
Nawafleh et al,30 the perception of general safety was determined by
74% and management support for patient safety was approved by
31
39% in the study performed by Mikušová et al. The lowest score,
35%, was obtained for patient safety in terms of management support
for patient safety in the study performed by Hellings et al.32
In line with the literature, the general perception of safety holds that
procedures and systems are good at preventing errors and that there
are not many patient safety problems. Hospital management provides
a business climate that promotes and prioritizes patient safety.8 When
the literature is reviewed, it is seen that the level of the dimension of
management support for patient safety is perceived to be lower in com-
parison with other dimensions regarding hospital safety culture.
EMRs provide several benefits for patient safety in terms of reduc-
tion of medical errors and undesirable handwritten errors in medical
practice.33 Errors that may arise in health institutions can lead to fatal
problems. In order to minimize medical errors, it is necessary to attach
more importance to EMR applications in health institutions and to cre-
ate a culture of patient safety. Putting educational support behind the
use of EMR systems in health institutions makes a greater contribution
to the use of EMRs.16 Therefore, nurses and other health profes-
sionals should be trained in information technologies and EMRs.
Moreover, by preventing computer workstations from obstructing
the workflow, nurses' satisfaction levels with EMR use could be
increased. Patient safety culture is created first of all with manage-
ment support, and then by teamwork, compliance with rules, educa-
tion, the participation of employees, and the establishment of a safe
health system.29-34 Management support is a very important factor
in the creation of a culture of patient safety in hospitals. Therefore,
it is important for the management to attach importance to and put
support behind patient safety culture. Staff recommendations in this
regard should also be considered to improve patient safety.
4.1 | Limitations of the study
The results of this study have limitations because they cannot be gen-
eralized to all nurses. The sample of this study consists of nurses
working in public hospitals in one Turkish province. Future studies
using broader samples could produce more wide‐ranging results.
5 | CO NC LUSIO NS
EMRs and patient safety are important concepts for nursing and impor-
tant components of health care provision in the health institutions of
Turkey. Based on the results of this study, improvements are necessary
in the use of medical records and the development of patient safety.
For this reason, it is necessary to train other health personnel in EMR
use and patient safety, and, in line with this aim, relevant policies and
programmes must be developed. In order to provide effective patient
safety, executive support must also be maintained.
CONFLIC T OF INT E RE ST
The authors declare no conflict of interest.
FUNDING
This study received no funding.
ÖZER AND ŞANTAŞ
ORCID
Özlem Özer https://orcid.org/0000-0002-7238-5371
Fatih Şantaş https://orcid.org/0000-0002-0595-4183
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SUPPORTING INFORMATION
Additional supporting information may be found online in the
Supporting Information section at the end of the article.
How to cite this article: Özer Ö, Şantaş F. Effects of elec-
tronic medical records on patient safety culture: The perspec-
tive of nurses. J Eval Clin Pract. 2019;1–7. https://doi.org/
10.1111/jep.13174