Skip to main content
Download PDF

The relationship between patient safety culture and attitudes toward incident reporting among registered nurses

BMC Health Services Research volume 25, Article number: 612 (2025) Cite this article

Abstract

Background

Patient safety is a primary concern in healthcare due to errors and low incident reporting rates. A strong safety culture and positive attitudes towards reporting are crucial for improving patient safety culture (PSC). Overcoming barriers and conducting research can enhance incident reporting, foster a safety culture, and improve patient outcomes.

Aim

To investigate the relationship between patient safety culture and attitudes toward incident reporting among Jordanian nurses.

Methodology

This study employed a cross-sectional descriptive correlational design. A convenient sample of 307 registered staff nurses from Jordanian hospitals across different sectors was selected. Validated and translated questionnaires, which included the Incident Reporting Culture Questionnaire and the Hospital Survey on Patient Safety Culture, were used for data collection. Statistical analyses, such as descriptive and inferential statistics (including Pearson correlation, independent sample t-test, one-way ANOVA, and hierarchical regression analysis), were employed to address research questions using SPSS version 26.

Results

The findings revealed that the Patient Safety Culture (PSC) organizational learning dimension had the highest positive response rate (70.6%), while the hands-off and transition dimension had the lowest score (24.9%). Approximately 43.6% of participants reported no events in the last 12 months, whereas only 4.2% reported experiencing 12 or more events. The overall perception of patient safety was rated as ‘very good’ by 55.7% of the participants. The results from the Incident Reporting Culture Questionnaire (IRCQ) indicated a moderate overall willingness among nurses to report incidents, along with positive attitudes toward implementing lessons learned from errors and offering feedback on incident reports. Significant differences in attitudes toward incident reporting were observed based on the type of hospital (p = 0.037) and working hours (p = 0.012). Moreover, significant correlations were found between Patient Safety Culture dimensions and Incident Reporting Culture Questionnaire dimensions. The most robust positive correlation was observed between the feedback and communication about errors dimension in Patient Safety Culture and the learning from errors dimension in Incident Reporting Culture Questionnaire (r = 0.401, p = 0.000). Through hierarchical multiple regression analysis, it was demonstrated that Patient Safety Culture significantly predicted attitudes toward incident reporting (β = 0.441, p < 0.001), while controlling for demographic variables.

Conclusion

This study discovered a positive correlation between patient safety culture and attitudes toward incident reporting among Jordanian nurses. Enhancing patient safety culture and adopting non-punitive measures can effectively improve incident reporting behavior within healthcare settings.

Peer Review reports

Introduction

The value of patient safety in healthcare cannot be overstated. According to the Institute of Medicine (IOM), medical errors cause between 44,000 to 98,000 deaths annually in the United States alone [1]. One crucial strategy for improving patient safety is the diligent reporting of incidents, which plays a pivotal role in identifying and addressing the contributing factors behind medical errors. Nurses are critical in incident reporting as they are often the first to identify and report such events in healthcare settings [2]. However, the absence of a robust patient safety culture in many medical facilities remains a significant challenge [3], including in Jordan [4]. Patient safety culture, defined by values, attitudes, and behaviors that influence an organization’s commitment to patient safety, is characterized by openness, transparency, and continuous improvement, essential for encouraging incident reporting and learning from errors [5]. Many healthcare organizations lack a strong patient safety culture, leading to insufficient support for incident reporting and reluctance to learn from mistakes. Studies have found that low rates of incident reporting among nurses are linked to a poor patient safety culture. For example, Yusuf and Irwan found in a systematic review that nurses who perceived a weak patient safety culture were less likely to report incidents, even when they recognized the potential for harm [6]. Similarly, Mihdawi et al. found that nurses who reported a lack of organizational support for patient safety were less likely to report incidents [7]. The willingness of nurses to disclose incidents is influenced by their perceptions of reporting accidents and the prevailing patient safety culture in their workplace [8]. The research underscores that nurturing a positive patient safety culture significantly enhances the likelihood of nurses reporting incidents [9], and factors such as fear of punitive measures, perceived benefits of reporting, and confidence in the reporting process influence nurses’ attitudes towards incident reporting [10].

In Jordan, several studies have been conducted to assess the state of PSC and incident reporting practices among healthcare professionals. A study involving 307 nurses and 144 physicians across seven hospitals found that nurses were more aware of incident reporting systems than physicians. However, both groups identified significant barriers to reporting, including the belief that reporting near misses was futile, lack of feedback, and fear of disciplinary actions [11]. Research involving 391 nurses from seven hospitals revealed that positive responses to PSC dimensions ranged from 20.0 to 74.6%, which are lower than benchmarks set by the Agency for Healthcare Research and Quality [12]. A study with 658 nurses highlighted strengths in teamwork within units but identified areas requiring improvement, such as communication openness, staffing, handoffs and transitions, non-punitive responses to errors, and teamwork across units. The study emphasized the need to shift from a culture of blame to one that supports open communication and learning from errors [13]. These studies were conducted in Jordan to address the critical need for understanding and improving patient safety within the country’s healthcare system. By identifying existing perceptions, practices, and barriers related to PSC and incident reporting. This study examines research on patient safety culture levels and nurses’ attitudes, willingness, and intentions to report errors, emphasizing factors related to their attitudes and willingness to disclose errors.

Methodology

Study design

The research design used in this study was a descriptive, cross-sectional design.

Settings and sample size

A convenience sampling among participants included 307 hospitalized nurses working in all departments at government and private hospitals; governmental hospital (Prince Hamza Hospital, located in Amman with 460 beds capacity and 42 specialties, Al-Salt Hospital located in Al Balqa’a with a capacity of 350 beds, and Al-Zarqa Hospital located in Al Zarqa with a capacity of 500 beds), private hospitals (Specialty Hospital in Amman, the Jabal Alzaytoon Hospital, and the Al-Hikmah Hospital). Sample size calculation was calculated based on a correlation test to ensure that the study has a power of 0.95, alpha = 0.05, and a medium effect size of 0.3. The minimum target sample size is 307. Registered nurses working in government and private hospitals, actively involved in patient care and willing to participate in the study were included in this study, nurses on extended leave or not involved in direct patient care and newly hired nurses with limited experience in the hospital setting were excluded. The study conducted between October and November 2024.

Measurement

A self-reported questionnaire was distributed to nurses; the survey package was comprised of four main parts: 1. Sociodemographic Questionnaire: Age, gender, marital status, monthly income, years of experience.

HSOPSC (Hospital Survey on Patient Safety Culture): First developed by the Agency for Healthcare Research and Quality (AHRQ) in 2004 [14]. The HSOPSC is a 42-item instrument grouped into 12 composite dimensions and nine non-dimensional items, including two safety assessment items and seven demographic items. Each dimension is represented by three to five items measured with a 5-point.

Likert scale to ascertain agreement (strongly disagree to strongly agree) or frequency (never to always). The HSOPSC scoring involves calculating the average score for each dimension and the overall patient safety culture score. To calculate the average score for each dimension, the scores for all the items within that dimension are summed and divided by the number of items in that dimension. The overall patient safety culture score is calculated by averaging all 12 dimensions. The HSOPSC also provides a percentage positive response score for each dimension, which represents the percentage of respondents who answered positively to the items within that dimension. The percentage of positive response scores can be calculated by dividing the number of positive responses by the total number of responses and multiplying by 100.

These cut points are used to interpret the overall patient safety culture score and the scores for each of the 12 dimensions. A score above the neutral cut point is considered positive, while a score below the neutral cut point is considered negative. The Arabic version of the survey, translated and validated by (Al-Nawafleh et al.) [15], where the Cronbach alpha was 0.797, was used in the current study.

Incident Reporting Culture Questionnaire (IRCQ)

The 20-item Incident Reporting Culture Questionnaire (IRCQ) consisted of four factors answered on a five- point Likert scale [16]. The four factors comprised of Factor 1: Application of learning from errors, with five items and a score range value of 5 to 25; Factor 2: Readiness to provide feedback on incident reports, with six items (score range 6 to 30); Factor 3: Collegial atmosphere of unpleasantness and punishment, with five items and a possible score range value of 5 to 25; Factor 4: Incident management confidential and system driven, with four items (score range 4 to 20) [16]. As per Mjadu and Jarvis [17], the items of the scale are all summed together to generate a total IRCQ score.

The authors of the questionnaire tested reliability and validity: Criterion validity r = 42, p = 0.001; Cronbach alpha for the total IRCQ questionnaire was 0.83, and Cronbach alpha for Factors 1 to 4 were 0.73, 0.73, 0.70, 0.68, respectively [16]. There are no established cut points for interpreting the IRCQ scores. However, higher scores on the questionnaire indicate a more positive incident- reporting culture within the organization. Researchers may compare the scores of different units within the same organization to identify areas that need improvement. The survey was introduced to nurses in the Arabic language.

Data analysis

Data analysis was conducted using SPSS version 26 software. Descriptive analyses were initially conducted to explore the data and to describe the sample, such as calculating frequencies, means, and standard deviations for each variable. Continuous variables were reported as means and standard deviations. The categorical variables were reported as percentages. Inferential analysis was conducted to analyze the study’s second research question using statistical tests, t-tests, and one-way ANOVA. The relationship between PSC and attitudes toward incident reporting was tested using the Pearson correlation and regression analysis. Based on this statement, the p-value ≤ 0.05 was considered statistically significant.

Results

Description of the population and sample

The response rate of this study is 91.3%, with 307 nurses participating from both governmental and private hospitals in Jordan. Incomplete surveys were excluded. The majority age group was 22–32 years (53%), with females making up 59.9% of the respondents, reflecting the overall gender composition of Jordanian nursing. Participants’ experience ranged primarily from 1-6 years (35.8%). Regarding safety training, 57.3% of nurses reported having received training, indicating significant engagement in safety practices (Table 1).

Table 1 Characteristics of participants (N = 307)
Full size table

Patient safety in the selected hospitals was measured by assessing different components. The PSC organizational learning dimension scored the highest positive response rate (70.6%), whereas the PSC hands-off and transition dimension scored the lowest positive response rates (24.9%) (Table 2).

Table 2 Composite levels for the PSC (N = 307)
Full size table

Regarding the frequency of events reported, nearly half of the participants (N = 134, 43.6%) reported no events in the last 12 months, while only 13 (4.2%) of participants reported that 12 or more events happened in the last 12 months (Fig. 1).

Fig. 1
figure 1

Frequency of events reported in the last 12 months

Full size image

For the overall perception of safety culture, participants were asked to respond to one question rated on five points. The findings showed that more than half of the participants (N = 171, 55.7%) rated their hospitals as having a “very good “level of PSC, while only 5 (1.6%) rated their institutions as “poor “in PSC.

For IRCQ 1, the average score was 17.5 ± 2.9, with 61.2% of nurses providing positive responses, indicating a favorable attitude towards learning from errors. The Cronbach’s alpha coefficient was 0.752, suggesting satisfactory internal consistency. For IRCQ 2, the average score was 21.16 ± 3.14, with 63.2% of nurses ready to provide feedback on incident reports, indicating positive inclination. The Cronbach’s alpha coefficient was 0.744, indicating acceptable internal consistency. For IRCQ 3, the mean score was 13.6 ± 2.95, with 50.4% of nurses reporting unfavorable collegial atmospheres. The Cronbach’s alpha coefficient was 0.659, indicating moderate internal consistency. For IRCQ 4, the average score was 12.8 ± 2.24, with 45.9% of nurses favoring a confidential, system-driven incident management approach. The Cronbach’s alpha coefficient was 0.661, indicating moderate internal consistency. The IRCQ total scale showed an average score of 65.1 ± 7.92, with 55.2% positive responses, suggesting a moderate overall willingness to report incidents. The Cronbach’s alpha coefficient was 0.704, indicating acceptable internal consistency (Table 3).

Table 3 Incident reporting attitude and willingness levels (N = 307)
Full size table

Participants from governmental hospitals had a mean score of 65.83 ± 7.32 for attitudes toward incident reporting, while private hospital nurses scored slightly lower at 63.89 ± 8.70, indicating a higher attitude among governmental hospital nurses. Levene’s test (F = 5.889, p = 0.016) showed unequal variances. The t-test revealed a significant difference between the groups (t = 2.008, df = 216.865, p = 0.046) with a 95% confidence interval of 0.03601 to 3.82876. Full-time participants had a mean score of 64.61 ± 8.068 (standard error mean = 0.49945), while part-time participants scored 67.78 ± 6.487 (standard error mean = 0.95650). Levene’s test (F = 1.706, p = 0.192) showed equal variances, and the t-test indicated a significant difference between full-time and part-time workers (t = − 2.523, df = 305, p = 0.012) (Table 4).

Table 4 Differences in IRCQ and PSC among Jordanian nurses based on their demographic characteristics
Full size table

As illustrated in Table 5, the results revealed a significant positive relationship between the total score of PSC and the total score of IRCQ (r = 0.473, p = 0.000). Additionally, many PSC dimensions were positively or negatively correlated with IRCQ dimensions. For example, the PSC Feedback and communication about errors dimensions had the strongest value, significantly positively correlated with IRCQ learning from errors dimension (r = 0.401, p = 0.000). On the contrary, the strongest significant negative correlation was between the PSC staffing dimension and IRCQ learning from the errors dimension (r = − 0.159, p = 0.005).

Table 5 The relationship between PSC dimensions and IRCQ dimensions (N = 307)
Full size table

Hierarchical multiple regression analysis examined the unique relationship between PSC and IRCQ. Type of Hospital, Employment, and Medical Department was entered into the first regression analysis model, while PSC was entered into the second model. Overall, the two regression models were significant, P < 0.001. For the final model, R-squared = 0.25, adjusted R-squared = 0.24. Demographic variables accounted for 7% of the variance in nurses’ performance, while PSC accounted for 19% additional variance above and beyond the 7% accounted for by the first model. In the second model (Table 6), both Employment (B = 0.143, P = 0.005) and PSC (B = 0.441, P < 0.001) significantly predicted IRCQ.

Table 6 Multiple regression analysis to examine the unique relationship between PSC and IRCQ
Full size table

Discussion

The study’s findings revealed both similarities and differences when compared to existing national and international literature as follows:

Levels of PSC and attitudes toward IR

The findings indicate that healthcare professionals in Jordanian hospitals generally perceive patient safety culture (PSC) positively. Notably, “PSC organizational learning” received the highest positive perception, suggesting that hospitals prioritize learning from incidents and fostering continuous improvement. This aligns with studies by Chen and Li [18], El-Jardali et al. [19], and Tereanu et al. [20], which highlight the role of organizational learning in enhancing PSC. Nurses, in particular, view their institutions as proactive in incident-based learning, reinforcing their confidence in the system’s ability to evolve and improve [21]. This proactive stance is critical for reducing errors and ensuring patient safety, as supported by Raeissi et al. [22]. The emphasis on organizational learning suggests a cultural shift where error reporting is encouraged, not penalized. Studies by Burlison et al. [23], Waterson et al. [24], and Malak et al. [25] reinforce this, demonstrating how hospitals that integrate learning into their safety strategies experience greater improvements in patient outcomes. However, despite this progress, the least favorable perception was related to the “hands-off and transition approach,” indicating persistent weaknesses in communication and handovers. Poor transitions of care remain a well-documented risk factor for adverse events, as highlighted by [26,27,28,29,30]. The fact that over 50% of Jordanian nurses rated their hospitals as “very good” in terms of PSC is a promising sign, reflecting institutional efforts to prioritize patient safety through structured policies and teamwork [7, 25]. This aligns with earlier research [13, 31], further supported by the World Health Organization, which recognized Jordan’s commitment to patient safety improvements [32]. One particularly noteworthy finding is that nurses highly valued feedback on incident reports, reinforcing the importance of transparent and constructive feedback mechanisms. Studies support the notion that well-structured feedback enhances reporting behaviors and contributes to a cycle of continuous improvement [33, 34]. This study highlights the importance of bridging the gap between learning and practice, suggesting that while PSC is perceived positively, further efforts are needed to improve communication during patient transitions. Hospitals should focus on structured handover protocols and interdisciplinary communication training to mitigate risks associated with care transitions [35,36,37,38].

Differences in IRCQ and PSC among Jordanian nurses based on their demographic characteristics

The present study revealed significant variations in attitudes toward incident reporting and patient safety culture (PSC) among Jordanian nurses based on demographic characteristics such as hospital type, weekly working hours, and working department. Governmental hospitals exhibited marginally higher incident reporting attitudes compared to private hospitals, supported by an independent samples t-test showing higher mean scores for governmental hospital nurses. This aligns with prior research linking positive incident-reporting attitudes to a supportive safety climate in hospitals [39]. Governmental hospitals typically prioritize patient safety and have robust reporting systems, while private hospitals might prioritize financial aspects, affecting their reporting culture [40, 41]. Similar patterns were found in Iran, where public hospital nurses demonstrated more positive incident-reporting attitudes due to a stronger safety culture and better resources [42]. The disparity, though statistically significant, was modest, suggesting other factors also play a role. Future research could explore the interaction between organizational and individual factors. The study also identified significant differences in incident reporting attitudes based on employment status, with part-time nurses exhibiting more favorable attitudes than full-time nurses, possibly due to lower burnout and fewer professional commitments [43, 44]. Limited research exists on the relationship between working hours and incident-reporting attitudes, but studies on other healthcare professionals suggest part-time employees have lower stress levels and higher job satisfaction, which may translate into better-reporting attitudes [45]. Furthermore, the study found significant variations in incident reporting attitudes and PSC based on the working department, with surgical department nurses reporting higher IRCQ and PSC scores than medical department nurses. Surgical departments, due to the complexity and invasiveness of procedures, often enforce stringent patient safety protocols, leading to a more positive safety climate and heightened incident reporting awareness [46]. These insights contribute to a deeper understanding of the complex dynamics influencing incident reporting attitudes and PSC within the nursing profession, offering valuable directions for future research and targeted interventions to enhance patient safety.

The relationship between PSC and attitude toward IR

The current study reveals a significant positive relationship between the total scores of PSC and IRCQ, indicating that as participants’ perception of patient safety culture improves, their attitude toward incident reporting becomes more positive. This underscores the interconnection between a positive patient safety culture and healthcare professionals’ willingness to report safety incidents. A robust patient safety culture encourages and supports incident reporting without fear of reprisal, viewing it as crucial for patient safety improvement [47]. The significant correlation between PSC and IRCQ scores suggests that healthcare professionals who perceive a positive patient safety culture are more likely to have positive attitudes toward incident reporting, seeing it as essential for identifying risks and enhancing safety outcomes [48]. This moderate positive correlation highlights the importance of nurturing a positive patient safety culture within healthcare organizations, promoting attitudes that support incident reporting, and enabling the capture and analysis of data for targeted interventions [49]. While this correlation suggests a relationship, it does not imply causation; factors such as organizational policies, leadership support, and resources influence incident-reporting attitudes. Further research is needed to explore this relationship’s underlying mechanisms and mediators. The study also finds a significant positive relationship between “Teamwork within a unit” and all attitude dimensions toward incident reporting (IRCQ), aligning with previous studies that emphasize team communication and collaboration in promoting safety culture and incident reporting. The “supervisor/manager expectations and actions promoting patient safety” dimension in PSC is positively associated with IRCQ dimensions like readiness of reporting, atmospheres of punishment, and incident management, suggesting that active promotion of patient safety by supervisors and managers increases comfort and reduces fear of retribution among healthcare professionals. Additionally, the “organizational learning” dimension in PSC is positively associated with IRCQ, indicating that healthcare professionals are more likely to value incident reporting when they perceive it as contributing to patient safety improvements. Conversely, the study shows a negative correlation between the “Staffing” PSC dimension and the “learning from errors” dimension of attitude toward incident reporting among Jordanian nurses. This suggests that lower perceptions of staffing levels correlate with decreased willingness to learn from errors and report incidents, consistent with research in other regions like Eastern Asia and Slovakia [50, 51]. Reasons for this negative correlation include the creation of a stressful work environment due to insufficient staffing, leading to increased workload and job dissatisfaction, which reduces the willingness to learn from errors and report incidents [52,53,54]. Inadequate staffing can also result in more errors and adverse events, negatively affecting patient outcomes and creating a culture of blame and fear of reprisal, further discouraging incident reporting and learning from errors [55,56,57]. Additionally, a lack of resources and support for incident reporting can hinder nurses’ willingness to report incidents if they feel their reports will not be taken seriously or result in meaningful action [58, 59].

These findings highlight the need to foster a safety culture in healthcare by promoting open communication, encouraging incident reporting, and providing feedback to healthcare workers. Further research is needed on the relationship between PSC and incident-reporting attitudes in diverse healthcare settings and the role of cultural norms, professional identity, and leadership.

Strengths and limitations

No study is perfectly designed to avoid all limitations, and this study is no exception. Its limitations include limited generalizability due to its specific context (Jordanian hospitals), the potential bias of self-reported data, the cross-sectional design limiting causal conclusions, a small sample size reducing statistical power, and a limited number of measured variables that may not fully capture factors influencing incident reporting behavior. Despite these limitations, the study provides valuable insights into the relationship between patient safety culture (PSC) and attitude toward incident reporting among Jordanian nurses. It used validated instruments, had a diverse sample, and had practical implications for healthcare organizations and policymakers. The findings contribute to the literature on PSC and incident-reporting behavior, particularly in the Middle Eastern context, and offer a baseline for future research in this area.

Conclusions

In conclusion, a positive perception of participants toward PSC and attitude toward IR. Additionally, the findings showed that PSC dimensions, including organizational learning, non-punitive response, staffing, and hands-off were significant predictors of attitude toward incident reporting. The study’s findings suggest that developing a positive patient safety culture and providing a non-punitive response to incidents can increase incident-reporting behavior among Jordanian nurses.

Data availability

All data that were analyzed during this study are included in this article, and further inquiries can be directed to the corresponding author.

References

  1. Bates DW, Singh H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Aff (Millwood). 2018;37(11):1736-43.

  2. Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, et al. Nurses’ perceptions of patient safety culture in three hospitals in Saudi Arabia. J Nurs Scholarsh. 2018;50(4):422−31.

  3. Kusumawati AS, Handiyani H, Rachmi SF. Patient safety culture and nurses’ attitude on incident reporting in Indonesia. Enferm Clín. 2019;29:47–52.

  4. Rashed A, Hamdan M. Physicians’ and nurses’ perceptions of and attitudes toward incident reporting in Palestinian Hospitals. J Patient Saf. 2019;15(3):212-7.

  5. Dhamanti I, Leggat S, Barraclough S. Practical and cultural barriers to reporting incidents among health workers in Indonesian public hospitals. J Multidiscip Healthc. 2020;13:351-9.

  6. Yusuf Y, Irwan AM. The influence of nurse leadership style on the culture of patient safety incident reporting: a systematic review. Br J Healthc Manage. 2021;27(6):1–7.

  7. Mihdawi M, Al-Amer R, Darwish R, Randall S, Afaneh T. The influence of nursing work environment on patient safety. Workplace Health Saf. 2020;68(8):384−90.

  8. Farokhzadian J, Dehghan Nayeri N, Borhani F. The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC Health Serv Res. 2018;18(1):654.

  9. Schwendimann R, Zimmermann N, Küng K, Ausserhofer D, Sexton B. Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study. BMJ Qual Saf. 2013;22(1):32–41.

  10. Tanya H, Samia C, Alan JF. Sociocultural factors influencing incident reporting among physicians and nurses: understanding frames underlying self- and peer-reporting practices. J Patient Saf. 2017;13(3):129−37.

  11. AbuAlRub RF, Al-Akour NA, Alatari NH. Perceptions of reporting practices and barriers to reporting incidents among registered nurses and physicians in accredited and nonaccredited J ordanian hospitals. J Clin Nurs. 2015;24(19–20):2973-82.

  12. Suliman M, Aljezawi M, AlBashtawy M, Fitzpatrick J, Aloush S, Al-Awamreh K. Exploring safety culture in Jordanian hospitals: a baseline study. J Nurs Care Qual. 2017;32(3):E1-7.

  13. Khater WA, Akhu-Zaheya LM, Al‐Mahasneh SI, Khater R. Nurses’ perceptions of patient safety culture in Jordanian hospitals. Int Nurs Rev. 2015;62(1):82–91.

  14. Sorra JS, Nieva VF. Hospital survey on patient safety culture. Westat; 2004. pp. 290-96-0004. http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospcult.pdf.

  15. Al-Nawafleh A, Abu-Helalah MA, Hill V, Masoud MI, Al-Mahasneh HA, Al Salti ET. Patient safety culture in Jordanian hospitals. Health Sci J. 2016;10(5):1.

  16. Chiang HY, Hsiao YC, Lin SY, Lee HF. Incident reporting culture: scale development with validation and reliability and assessment of hospital nurses in Taiwan. Int J Qual Health Care. 2011;23(4):429−36.

  17. Mjadu TM, Jarvis MA. Patients’ safety in adult ICUs: registered nurses’ attitudes to critical incident reporting. Int J Afr Nurs Sci. 2018;9:81–86.

  18. Chen IC, Li HH. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Serv Res. 2010;10:152.

  19. El-Jardali F, Sheikh F, Garcia NA, Jamal D, Abdo A. Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement. BMC Health Serv Res. 2014;14:122.

  20. Tereanu C, Sampietro G, Sarnataro F, Siscanu D, Palaria R, Savin V, et al. Survey on patient safety culture in the Republic of Moldova: a baseline study in three healthcare settings. Clujul Med. 2018;91(1):65–74.

  21. Chegini Z, Kakemam E, Asghari Jafarabadi M, Janati A. The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey. BMC Nurs. 2020;19:89.

  22. Raeissi P, Reisi N, Nasiripour AA. Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses. J Patient Saf. 2018;14(4):213−26.

  23. Burlison JD, Quillivan RR, Kath LM, Zhou Y, Courtney SC, Cheng C, et al. A multilevel analysis of U.S. hospital patient safety culture relationships with perceptions of voluntary event reporting. J Patient Saf. 2020;16(3):187−93.

  24. Waterson P, Carman EM, Manser T, Hammer A. Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies. BMJ Open. 2019;9(9):e026896.

  25. Malak MZ, Salouk J, Al-Shawawreh R, Al-Kamiseh H, Ayed A. Perceptions of patient safety culture among emergency room nurses in Jordanian accredited hospitals. J Nurs Manag. 2022;30(7):3131-8.

  26. Mansour H, Abu Sharour L. Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload. J Healthc Qual Res. 2021;36(6):370-7.

  27. Garosi E, Kalantari R, Zanjirani Farahani A, Zuaktafi M, Hosseinzadeh Roknabadi E, Bakhshi E. Concerns about verbal communication in the operating room: a field study. Hum Factors. 2020;62(6):940−53.

  28. Rhudy LM. Handoff from operating room to intensive care unit: specific pathways to decrease patient adverse events. Nurs Clin North Am. 2019;54(3):335−45.

  29. Raeisi A, Rarani MA, Soltani F. Challenges of patient handover process in healthcare services: a systematic review. J Educ Health Promot. 2019;8:173.

  30. Dalky HF, Al-Jaradeen RS, AbuAlRrub RF. Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimens Crit Care Nurs. 2020;39(6):339−47.

  31. AbuAlRub RF, Abu Alhijaa EH. The impact of educational interventions on enhancing perceptions of patient safety culture among Jordanian senior nurses. Nurs Forum. 2014;49(2):139−50.

  32. World Health Organization. Regional Office for the Eastern M. Patient safety tool kit. Cairo: World Health Organization. Regional Office for the Eastern Mediterranean; 2015.

  33. Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ. 2019;366:l4185.

  34. Hamed MMM, Konstantinidis S. Barriers to incident reporting among nurses: a qualitative systematic review. West J Nurs Res. 2022;44(5):506−23.

  35. Jabarkhil AQ, Tabatabaee SS, Jamali J, Moghri J. Assessment of patient safety culture among doctors, nurses, and midwives in a public hospital in Afghanistan. Risk Manage Healthc Policy. 2021;14:1211-7.

  36. Tabatabaee SS, Ghavami V, Javan-Noughabi J, Kakemam E. Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records. BMC Health Serv Res. 2022;22(1):1420.

  37. Oweidat I, Al-Mugheed K, Alsenany SA, Abdelaliem SM, Alzoubi MM. Awareness of reporting practices and barriers to incident reporting among nurses. BMC Nurs. 2023 3;22(1):231.

  38. Al-Mugheed K, Bayraktar N. Patient safety attitudes among critical care nurses: a case study in North Cyprus. Int J Health Plan Manage. 2020;35(4):910−21.

  39. Gurková E, Kalánková D, Kurucová R, Žiaková K. Assessment of patient safety climate by nurses in Slovak Public and private hospitals. J Nurs Manag. 2020;28(7):1644-52.

  40. Hwang JI, Kim SW, Chin HJ. Patient participation in patient safety and its relationships with nurses’ patient-centered care competency, teamwork, and safety climate. Asian Nurs Res (Korean Soc Nurs Sci). 2019;13(2):130-6.

  41. Hussein M, Pavlova M, Ghalwash M, Groot W. The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Serv Res. 2021;21(1):1057.

  42. Khoshakhlagh AH, Khatooni E, Akbarzadeh I, Yazdanirad S, Sheidaei A. Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC Health Serv Res. 2019;19(1):1009.

  43. Jakimowicz S, Perry L, Lewis J. Insights on compassion and patient-centred nursing in intensive care: a constructivist grounded theory. J Clin Nurs. 2018;27(7–8):1599−611.

  44. Labrague LJ, Obeidat AA. Transformational leadership as a mediator between work-family conflict, nurse-reported patient safety outcomes, and job engagement. J Nurs Scholarsh. 2022;54(4):493–500.

  45. Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021;69(1):96–102.

  46. Joung H-W, Choi E-K, Taylor JJ. Investigating differences in job-related attitudes between full-time and part-time employees in the foodservice industry. Int J Contemp Hospital Manage. 2018;30(2):817−35.

  47. Jaber HJ, Abu Shosha GM, Al-Kalaldeh MT, Oweidat IA, Al-Mugheed K, Alsenany SA, Farghaly Abdelaliem SM. Perceived relationship between horizontal violence and patient safety culture among nurses. Risk Manage Healthc Policy. 2023:1545-53.

  48. Alzoubi MM, Al-Mugheed K, Oweidat I, Alrahbeni T, Alnaeem MM, Alabdullah AA, Abdelaliem SM, Hendy A. Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses. BMC Psychol. 2024;12(1):495.

  49. Ayyad A, Baker NA, Oweidat I, Al-Mugheed K, Alsenany SA, Abdelaliem SM. Knowledge, attitudes, and practices toward patient safety among nurses in health centers. BMC Nurs. 2024;23(1):171.

  50. Oweidat IA, Atiyeh H, Alosta M, Al-Mugheed K, Saeed Alabdullah AA, Alzoubi MM, Farghaly Abdelaliem SM. The influence of hospital accreditation on nurses’ perceptions of patient safety culture. Hum Res Health. 2024;22(1):36.

  51. Lee SE, Quinn BL. Safety culture and patient safety outcomes in East Asia: a literature review. West J Nurs Res. 2020;42(3):220−30.

  52. Oweidat I, Alzoubi M, Shosha GA, Ta’an WA, Khalifeh A, Alzoubi MM, Al-Mugheed K, Alabdullah AA, Abdelaliem SM. Relationship between emotional intelligence and quality of healthcare among nurses. Front Psychol. 2024;15:1423235.

  53. Mderis W, Shosha GA, Oweidat I, Al-Mugheed K, Abdelaliem SM, Alabdullah AA, Alzoubi MM. The relationship between emotional intelligence and readiness for organizational change among nurses. Medicine. 2024;103(32):e38280.

  54. Alzoubi MM, Khalid AM, Al-Zoubi KM, Al-Oweidat I, Alabdullah AA, Abdelaliem SM. Quality management for nurses performance and commitment on government hospitals: a cross-sectional study. Medicine. 2025;104(1):e40085.

  55. Oweidat I, Abu Shosha G, Al-Harazneh R, Al-Mugheed K, Alzoubi M, Saeed Alabdullah AA, Farghaly Abdelaliem SM. Nurses’ perceptions of job security and performance: A comparative study between governmental and private hospitals. PloS One. 2025;20(3):e0318412.

  56. Farghaly Abdelaliem SM, Al-Mugheed K, Alzoubi MM, Al-Oweidat I, Hamouda GM. The effect of nursing shared governance educational program on nurse managers’ knowledge for sustainable nursing excellence and empowerment. PLoS One. 2025;20(2):e0307798.

  57. Alzoubi MM, Al-Mahasneh A, Al-Mugheed K, Al Barmawi M, Alsenany SA, Farghaly Abdelaliem SM. Medication administration error perceptions among critical care nurses: a cross-sectional, descriptive study. J Multidisciplin Healt hc. 2023;16:1503-12.

  58. Al-Mugheed K, Farghaly SM, Baghdadi NA, Oweidat I, Alzoubi MM. Incidence, knowledge, attitude and practice toward needle stick injury among nursing students in Saudi Arabia. Front Public Health. 2023;11:1160680.

  59. Oweidat I, Shosha GA, Dmaidi K, Nashwan AJ. The association of patient safety culture with intent to leave among Jordanian nurses: a cross-sectional study. BMC Nurs. 2023;22(1):227.

Download references

Acknowledgements

The authors extend their appreciation to Princess Nourah bint Abdulrahman University Researchers Supporting (PNURSP2025R844), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Funding

Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2025R844), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Author information

Authors and Affiliations

  1. Jordanian Ministry of Health, Zarqa Health Directorate, Amman, Jordan

    Nabel Alsobou

  2. Psychiatric and Mental Health Nursing, Zarqa University, Zarqa, Jordan

    Ahmad Hussien Rayan

  3. School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia

    Manal Hassan Baqeas

  4. Faculty of Nursing, Community Health Nursing, Al al-Bayt University, P.O. Box: 130040, Al- Mafraq, 25113, Jordan

    Mohammed Sa’d ALBashtawy & Islam Ali Oweidat

  5. Community and Mental Health Nursing Department, Zarqa University, Zarqa, Jordan

    Islam Ali Oweidat

  6. College of Nursing, Riyadh Elm University, Riyadh, Saudi Arabia

    Khalid Al-Mugheed

  7. Department of Nursing Management and Education, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia

    Sally Mohammed Farghaly Abdelaliem

Authors
  1. Nabel Alsobou
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Ahmad Hussien Rayan
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Manal Hassan Baqeas
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Mohammed Sa’d ALBashtawy
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Islam Ali Oweidat
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Khalid Al-Mugheed
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Sally Mohammed Farghaly Abdelaliem
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

NA, AHR, and MHB performed the literature search, and collect and interpret the data. NA, AHR, MHB, MSA, IAO, and A.R.A. drafted the work and contributed to the writing of this manuscript. SM, AHR, MHB, and MSA performed the analysis. KM, AHR, MHB, MSA, and IAO edited and drafted the final version of this manuscript. IAO reviewed the final version to be published.

Corresponding author

Correspondence to Islam Ali Oweidat.

Ethics declarations

Ethics approval and consent to participate

The authors’ permission to use the tools was gained. The IRB of Al-Zarqa University provided ethical approval (8/2022). The study complied with all ethical guidelines and regulations set forth by the ethics committee. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review at all sites. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alsobou, N., Rayan, A.H., Baqeas, M.H. et al. The relationship between patient safety culture and attitudes toward incident reporting among registered nurses. BMC Health Serv Res 25, 612 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12763-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12763-0

Keywords

BMC Health Services Research

ISSN: 1472-6963

Contact us