The relationship between error experience and patient safety culture with safe activities of emergency nurses

The present study is one of the pioneering studies in determining the relationship between error experience and PSC with the safe activities of emergency nurses. The findings showed that the overall perception of patient safety, feedback and communication about errors, and the existence of an error reporting system in the organization have a significant and direct relationship with safe nursing activities.

In this study, the mean score of PSC among emergency nurses is 3.24 out of 5, indicating the existence of a higher safety culture among emergency nurses. Our results align with the findings of Mi Lee et al.¹⁰ and with the research conducted by Nekui Moghadam et al.²³. The present study showed that the highest and lowest scores among the dimensions of PSC were related to teamwork within units and communication and information transfer, respectively. Teamwork showed a significant correlation with safe nursing activities, which is in line with the findings of Mi Lee et al.¹⁰. The high level of teamwork in this study could be attributed to factors such as high awareness of PSC, extended work experience, and training on patient safety. On the other hand, the lower score for communication and information transfer could be due to the overcrowding and critical conditions of emergency departments.

In examining the factors affecting safe nursing activities, the most important influencing factor was the awareness of PSC. Safety culture awareness is a basis for preparing appropriate strategies to enhance patient safety²⁴. Therefore, to promote patient safety in nursing activities, it is essential to raise awareness of PSC, and hospitals’ patient safety committees should establish systems to develop, train, and evaluate patient safety programs²⁵. These systems help healthcare organizations collect data and experiences and provide feedback to healthcare providers. Providing actionable feedback to nurses plays a crucial role in fostering a culture of safety by reinforcing positive behaviors, promoting learning from errors, and demonstrating that reporting contributes to tangible improvements²⁶. Increasing awareness of PSC and conducting patient safety training programs through proactive engagement of all hospital members, not only medical staff but also management, will be helpful in the formation of PSC. Training programs for emergency nurses should emphasize the importance of error reporting by clearly linking it to patient safety and quality care. These programs should focus on creating a non-punitive environment, using real-world examples to demonstrate the benefits of transparent reporting. Interactive methods, such as case studies and role-playing, can effectively engage nurses. Additionally, ongoing education and regular reinforcement of safety principles will ensure sustained commitment to error reporting and quality improvement²⁵.

The present study showed a significant relationship between understanding PSC and error reporting and the error reporting system with safe nursing activities, consistent with Mi Lee et al. study¹⁰. An effective error reporting system should prioritize anonymity, a non-punitive environment, and clear reporting guidelines to ensure nurses feel supported when reporting safety errors. Understanding safety culture is essential for improving nurses’ attitudes and behaviors, such as not reporting adverse events. Cultural attitudes in healthcare organizations, particularly in Iran, often emphasize hierarchy and fear of blame, which can discourage emergency nurses from reporting errors. To shift these attitudes, organizations should promote a just culture that prioritizes learning over punishment. Healthcare quality and patient safety can also be enhanced when healthcare managers devote sufficient support and resources to ensure teamwork, effective communication, and a blame-free culture²⁰.

The results of the present study showed that about half of the participants did not report any patient safety errors during the past year, and a third of them reported only 1–2 errors, which is consistent with Alkahf et al. study²⁷. Possible reasons for not reporting patient safety errors include high workload in emergency departments, ineffective communication, staff shortages, unclear responsibilities, disciplinary actions, lack of feedback and prompt solutions, complicated reporting systems, and improper implementation of relevant protocols^7,9. Therefore, providing a suitable communication structure, developing human resources, standardizing tasks and using protocols, clarifying roles, teamwork and task division, reducing overcrowding, distributing workloads, using appropriate equipment and innovative auxiliary devices, training, and promoting The culture of patient safety error reporting and the existence of a complete and robust and anonymous reporting system can lead to better results so that healthcare staff can freely report their errors to prevent their recurrence, and ultimately improve patient safety in hospital emergency units.

In this study, the mean score for safe nursing activities was 3.41, which differs from the studies by Kim et al.²⁸, and Yang²⁹. Reasons for these differences could include the research environment and various conditions, external influences, organizational policies, differing opinions, cultural and professional differences, and the tools used to collect data.

The study results also indicate a significant relationship between age and work experience in the emergency department and safe nursing activities, which is similar to the studies by Mi Lee et al.¹⁰ and Kim, et al.²⁵. The more clinical work experience, information skill, and responsibility of nurses, the more effectively safe nursing activity is performed²⁸. The positive effect of safety training courses may be attributed to their role in creating a shared group norm that explains the positive aspects of near mistakes, encourages learning from individual experiences, and can shape members’ willingness to participate in a collective effort to learn from mistakes³⁰.

It is important to note that nurses without clinical experience often provide direct nursing care in hospitals. Furthermore, nurses who have received specialized training in patient safety tend to demonstrate higher scores in patient safety nursing activities. Therefore, improving patient safety nursing activities by applying theoretical knowledge is essential. Continuous education programs and regular training enhance patient safety within nursing practices. By staying updated with the latest developments in healthcare, nurses can improve their skills and knowledge, ultimately leading to better patient outcomes. These educational initiatives also help nurses stay informed about best practices and new protocols, ensuring they can provide high-quality care while minimizing the risk of errors²⁸.