Team Psychological Safety on Patient Safety Events and Error Reporting among Nurses in a Level Ii Government Hospital

This study assessed the relationship between team psychological safety and patient safety event and error reporting among nurses in a tertiary hospital during the last quarter of 2025. A descriptive–correlational design was employed, using complete enumeration that yielded responses from 437 nurses. The study utilized an adapted version of Edmondson’s Psychological Safety Scale (1999) and selected dimensions of the Hospital Survey on Patient Safety Culture. Data were analyzed using descriptive statistics, chi-square tests, Cramer’s V, and Pearson r to determine relationships among demographic profile, psychological safety, and incident reporting. Results showed a moderate level of team psychological safety and a high overall level of patient safety event reporting, with lower scores observed in near-miss reporting and non-punitive response to error. Significant relationships were found between demographic variables and both psychological safety and reporting behaviors. Team psychological safety demonstrated significant positive correlations with frequency of events reported, non-punitive response to error, communication openness, and overall reporting levels. These findings support Edmondson’s Theory of Psychological Safety and align with Reason’s Swiss Cheese Model, highlighting the role of supportive team environments in strengthening patient safety. A Psychological Safety and Incident Reporting Enhancement Plan is proposed to address identified gaps and strengthen the hospital’s safety culture.

Psychological Safety; Incident Reporting; Patient Safety Events; Nurses

1. Abdelaliem, S. M. F., Alsenany, S., & Elkhateeb, R. A. (2022). Factors affecting patient safety culture from nurses’ perspectives. Healthcare, 10(10), 1889. doi:10.3390/healthcare10101889 [Google Scholar] [Crossref]

2. Adair, K. C., Quow, K., Frankel, A., Mosca, P. J., Profit, J., Sullivan, P., & Sexton, J. B. (2022). The improvement readiness scale: Development of a readiness measure for quality improvement in healthcare. BMJ Quality & Safety, 31(5), 379–386. https://doi.org/10.1136/bmjqs-2020-012773 [Google Scholar] [Crossref]

3. Agency for Healthcare Research and Quality. (2019). Patient safety primer: Incident reporting. https://psnet.ahrq.gov/primer/incident-reporting [Google Scholar] [Crossref]

4. Al Sabei, S., Al‐Riyami, M., Al‐Maqbali, M., Al‐Yaqoubi, F., Al‐Sinawi, H., & Alshehri, H. (2022). Barriers and facilitators of incident reporting among nurses in Oman: A cross‐sectional study. Journal of Nursing Management, 30(4), 1078–1086. https://doi.org/10.1111/jonm.13587 [Google Scholar] [Crossref]

5. Aljabari, S., Khatib, R., & Anwer, H. (2022). Communication openness and patient safety culture: A cross-sectional study. BMC Health Services Research, 22, Article 341. https://doi.org/10.1186/s12913-022-07761-3 [Google Scholar] [Crossref]

6. Alquwez, N., Cruz, J. P., Al Otaibi, R. S., Al Thobaity, A., & Almazan, J. (2023). Influence of nurse characteristics and work environment on patient safety culture: A cross-sectional study. Journal of Nursing Scholarship, 55(2), 324–333. https://doi.org/10.1111/jnu.12854 [Google Scholar] [Crossref]

7. Alsaleh, F. M., Abahussain, E. A., Altabtbaei, A., & Abahussain, A. (2023). Factors influencing patient safety incident reporting: A cross-sectional study in Kuwait. BMJ Open, 13(1), e065740. https://doi.org/10.1136/bmjopen-2022-065740 [Google Scholar] [Crossref]

8. Alshammari, A. S., Aldhuwayhi, T. Z., Alibrahim, N. O., et al. (2024). Assessment of patient safety culture among nurses working at tertiary care hospitals in Aljouf region, Saudi Arabia. Cureus, 16(4), e58429. doi:10.7759/cureus.58429 [Google Scholar] [Crossref]

9. Anwer, H., Aljabari, S., & Khatib, R. (2023). Feedback mechanisms and patient safety reporting behavior among nurses. International Journal for Quality in Health Care, 35(1), mzad004. https://doi.org/10.1093/intqhc/mzad004 [Google Scholar] [Crossref]

10. Arafat Abdeltwab, R., et al. (2025). The relation between psychosocial safety climate and work engagement among staff nurses. Egyptian Journal of Health Care. [Google Scholar] [Crossref]

11. Chen, I. C., Li, H. H., & Su, S. F. (2021). The relationship between work environment and patient safety culture among nurses in Taiwan. Journal of Nursing Management, 29(3), 537–545. https://doi.org/10.1111/jonm.13169 [Google Scholar] [Crossref]

12. Cho, H., Steege, L. M., & Arsenault Knudsen, É. N. (2023). Psychological safety, communication openness, nurse job outcomes, and patient safety in hospital nurses. Research in Nursing & Health, 46(4), 445–453. doi:10.1002/nur.22327 [Google Scholar] [Crossref]

13. Dalky, H. F., Al-Delaimy, W. K., & Al Momani, M. (2024). The impact of demographic characteristics on patient safety culture perceptions among nurses. Nursing Open, 11(1), 77–86. https://doi.org/10.1002/nop2.1794 [Google Scholar] [Crossref]

14. Dong, S., Wu, J., & Li, X. (2024). Influence of work experience on nurses’ safety attitudes: A cross-sectional study. Journal of Nursing Management. doi:10.1111/jonm.13922 [Google Scholar] [Crossref]

15. ECRI & The Just Culture Company. (2025). Just culture: Balancing accountability and learning in patient safety. ECRI Institute. [Google Scholar] [Crossref]

16. Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383. https://doi.org/10.2307/2666999 [Google Scholar] [Crossref]

17. Elmi, A. H., et al. (2025). Awareness of reporting practices and barriers to incident reporting among nurses in Mogadishu, Somalia. BMC Nursing, 24, Article 37xxx. doi:10.1186/s12912-025-03799-y [Google Scholar] [Crossref]

18. Frazier, M. L., Fainshmidt, S., Klinger, R. L., Pezeshkan, A., & Vracheva, V. (2017). Psychological safety: A meta‐analytic review and extension. Personnel Psychology, 70(1), 113–165. https://doi.org/10.1111/peps.12183 [Google Scholar] [Crossref]

19. Granel, N., et al. (2022). Patient safety culture and workload among hospital nurses: A cross-sectional analysis. Journal of Nursing Management, 30(5), 1320–1329. doi:10.1111/jonm.13553 [Google Scholar] [Crossref]

20. Hawsawi, A. O., & Alhajri, S. T. (2025). Psychological safety in nursing: A narrative review of leadership, burnout, and cultural barriers to patient safety. Journal of Nursing and Patient Safety and Policy. doi:10.4103/JNSPP.JNSPP_17_25 [Google Scholar] [Crossref]

21. Hirvikallio, J., Haaranen, A., & Hult, M. (2024). Psychological safety, social support, and commitment among nurse managers. Nordic Journal of Nursing Research, 44(1). doi:10.1177/20571585241238844 [Google Scholar] [Crossref]

22. Hu, H., Wang, C., Lan, Y., & Wu, X. (2022). Nurses’ turnover intention, hope and career identity: The mediating role of job satisfaction. BMC Nursing, 21, 43. doi:10.1186/s12912-022-00821-5 [Google Scholar] [Crossref]

23. Huang, C. H., Wu, H. H., & Lee, Y. C. (2020). The perceptions of patient safety culture among nurses in Taiwan. International Journal of Environmental Research and Public Health, 17(7), 2379. https://doi.org/10.3390/ijerph17072379 [Google Scholar] [Crossref]

24. Ip, W. Y., Lee, D. T. F., & Chan, S. W. C. (2025). Precursors of psychological safety in healthcare teams: A scoping review. Journal of Nursing Management, 33(2), 150–165. https://doi.org/10.1111/jonm.13837 [Google Scholar] [Crossref]

25. Ito, A., Sato, K., Yumoto, Y., Sasaki, M., & Ogata, Y. (2022). A concept analysis of psychological safety: Further understanding for application to health care. Nursing Open, 9(1), 467–489. doi:10.1002/nop2.1086 [Google Scholar] [Crossref]

26. Jaaffar, T., et al. (2023). Leadership, psychological safety, intrinsic motivation, and nurses’ voice behavior. Belitung Nursing Journal, 9(3), 255–270. doi:10.33546/bnj.2556 [Google Scholar] [Crossref]

27. Jeong, Y. (2025). The impact of just culture on nurses’ second victim experience and psychological well-being. Journal of Patient Safety. Advance online publication. https://doi.org/10.1097/PTS.0000000000001169 [Google Scholar] [Crossref]

28. Kharazmi, E., Bordbar, N., & Bordbar, S. (2023). Distribution of the nursing workforce in the world using the Gini coefficient. BMC Nursing, 22, 151. doi:10.1186/s12912-023-01313-w [Google Scholar] [Crossref]

29. Kim, E. M., Lee, Y. J., & Park, J. S. (2021). Psychological safety and its impact on the reporting of patient safety events: A cross-sectional study among nurses. International Journal for Quality in Health Care, 33(2), mzaa050. https://doi.org/10.1093/intqhc/mzaa050 [Google Scholar] [Crossref]

30. Kingston, M. J., Evans, S. M., & Smith, B. J. (2024). Psychological safety in healthcare: Implications for team learning and performance. BMJ Leader, 8(1), 14–20. https://doi.org/10.1136/leader-2022-000666 [Google Scholar] [Crossref]

31. Kyung, M., Kim, H., & Kim, J.-H. (2025). Factors associated with nursing students’ satisfaction with simulation-based assessments: Interaction between psychological safety and gender. BMC Medical Education, 25, 7648. doi:10.1186/s12909-025-07648-z [Google Scholar] [Crossref]

32. Kyung, M., Kim, H., & Kim, J.-H. (2025). Psychological safety and gender differences in communication. BMC Medical Education, 25, 7648. doi:10.1186/s12909-025-07648-z [Google Scholar] [Crossref]

33. LaPlante, K., Ginsburg, L. R., & Lingard, L. (2025). Team psychological safety in healthcare: A conceptual review. Academic Medicine, 100(1), 18–27. https://doi.org/10.1097/ACM.0000000000004961 [Google Scholar] [Crossref]

34. Lee, H., Kim, M., & Son, Y. J. (2023). Psychological safety and error reporting among nurses in hospital settings: The mediating role of communication openness. BMC Nursing, 22(1), 45. https://doi.org/10.1186/s12912-023-01132-1 [Google Scholar] [Crossref]

35. Lee, S., Lee, J., & Kim, Y. (2023). Relationship between psychological safety and incident reporting among nurses. Journal of Patient Safety. Advance online publication. https://doi.org/10.1097/PTS.0000000000001071 [Google Scholar] [Crossref]

36. Liu, C., Liu, W., Wang, Y., & Zhang, Z. (2020). Factors influencing incident reporting in nursing: A systematic review. Journal of Nursing Care Quality, 35(2), E7–E13. https://doi.org/10.1097/NCQ.0000000000000416 [Google Scholar] [Crossref]

37. Lu, M., Xia, R., Wang, R., & Zou, X. (2025). Network analysis of the relationships between voice behavior and team psychological safety climate among Chinese nurses. BMC Nursing, 24, 794. doi:10.1186/s12912-025-03388-z [Google Scholar] [Crossref]

38. Lu, M., Xia, R., Wang, R., & Zou, X. (2025). Relationships between voice behavior and team psychological safety climate. BMC Nursing, 24, 794. doi:10.1186/s12912-025-03388-z [Google Scholar] [Crossref]

39. Martínez, M. A., Navarro, C., & García, L. (2022). Enhancing patient safety event reporting through feedback and system redesign: A Spanish teaching hospital’s experience. BMJ Open Quality, 11(1), e001602. https://doi.org/10.1136/bmjoq-2021-001602 [Google Scholar] [Crossref]

40. Masibo, R. M., Kibusi, S. M., & Masika, G. M. (2024). Nurses, non-nurse healthcare providers, and clients’ perspectives, encounters, and choices of nursing gender in Tanzania: A qualitative descriptive study. BMC Nursing, 23, 353. doi:10.1186/s12912-024-02027-3 [Google Scholar] [Crossref]

41. Masibo, R. M., Kibusi, S. M., & Masika, G. M. (2024). Perspectives on nursing gender roles in Tanzania: A qualitative descriptive study. BMC Nursing, 23, 353. doi:10.1186/s12912-024-02027-3 [Google Scholar] [Crossref]

42. Maulana, I., & Setiawan, I. M. B. (2025). Enhancing nursing documentation through incident reporting and safety training: A systematic review. Journal of Pubnursing Sciences, 3(1), 42–50. doi:10.69606/jps.v3i01.217 [Google Scholar] [Crossref]

43. Montgomery, A., Chalili, V., Lainidi, O., Mouratidis, C., Maliousis, I., Paitaridou, K., et al. (2025). Psychological safety and patient safety: A systematic and narrative review. PLOS One, 20(4), e0322215. doi:10.1371/journal.pone.0322215 [Google Scholar] [Crossref]

44. Montgomery, A., Panagioti, M., & Maben, J. (2025). Psychological safety and patient safety outcomes: A narrative synthesis. International Journal for Quality in Health Care, 37(2), mzad016. https://doi.org/10.1093/intqhc/mzad016 [Google Scholar] [Crossref]

45. Munn, J., Bannon, S., & Everett, T. (2023). Leadership inclusiveness and psychological safety: Impact on error reporting in nursing. Journal of Nursing Management, 31(5), 1002–1011. https://doi.org/10.1111/jonm.13721 [Google Scholar] [Crossref]

46. Murray, C. (2023). Perceptions of punitive culture in nursing homes: Implications for error reporting. Journal of Patient Safety, 19(4), 298–304. https://doi.org/10.1097/PTS.0000000000001034 [Google Scholar] [Crossref]

47. Newman, A., Donohue, R., & Eva, N. (2017). Psychological safety: A systematic review of the literature. Human Resource Management Review, 27(3), 521–535. https://doi.org/10.1016/j.hrmr.2017.01.001 [Google Scholar] [Crossref]

48. O’Donovan, R., van Dun, D., & McAuliffe, E. (2020). Measuring psychological safety in healthcare teams: Developing an observational measure to complement survey methods. BMC Medical Research Methodology, 20, 203. doi:10.1186/s12874-020-01066-z [Google Scholar] [Crossref]

49. O’Donovan, R., van Dun, D., & McAuliffe, E. (2021). Healthcare professionals’ experiences of psychological safety in healthcare teams: A scoping review. Journal of Patient Safety, 17(7), e595–e602. doi:10.1097/PTS.0000000000000849 [Google Scholar] [Crossref]

50. Oweidat, I., Al-Mugheed, K., Alsenany, S. A., Abdelaliem, S. M. F., & Alzoubi, M. M. (2023). Awareness of reporting practices and barriers to incident reporting among nurses. BMC Nursing, 22, 191. doi:10.1186/s12912-023-01376-9 [Google Scholar] [Crossref]

51. Panesar, S. S., deSilva, D., Carson-Stevens, A., Cresswell, K. M., Salvilla, S. A., Slight, S. P., Javad, S., Shafi, S., Netuveli, G., Larizgoitia, I., Donaldson, L. J., Bates, D. W., & Sheikh, A. (2018). How safe is primary care? A systematic review. BMJ Quality & Safety, 25(7), 544–553. https://doi.org/10.1136/bmjqs-2015-004178 [Google Scholar] [Crossref]

52. Reason, J. (2000). Human error: Models and management. BMJ, 320(7237), 768–770. https://doi.org/10.1136/bmj.320.7237.768 [Google Scholar] [Crossref]

53. Roh, Y. S., Lim, E. J., & Kim, H. (2022). Gender differences in simulation learning and psychological safety. Nurse Education Today, 109, 105261. doi:10.1016/j.nedt.2021.105261 [Google Scholar] [Crossref]

54. Sadeghi, R., Naderi, Z., & Yusefi, A. R. (2025). How patient safety culture influences nurses’ responsibility: A structural equation modeling study. BMC Nursing, 24, 1414. doi:10.1186/s12912-025-04072-y [Google Scholar] [Crossref]

55. Sadeghi, R., Naderi, Z., & Yusefi, A. R. (2025). Patient safety culture and nurses’ responsibility. BMC Nursing, 24, 1414. doi:10.1186/s12912-025-04072-y [Google Scholar] [Crossref]

56. Sato, T., Kakuda, K., Sekiguchi, E., & Ishiseki, M. (2025). Psychological safety and burnout in nurses: A scoping review. Cureus, 17(9), e92411. doi:10.7759/cureus.92411 [Google Scholar] [Crossref]

57. Schnelli, A., Steiner, L. M., Bonetti, L., Levati, S., & Desmedt, M. (2024). A bachelor’s degree for entering the nursing profession: A scoping review for supporting informed health care policies. International Journal of Nursing Studies Advances, 6, 100171. doi:10.1016/j.ijnsa.2023.100171 [Google Scholar] [Crossref]

58. Smiley, R. A., et al. (2023). The 2022 National Nursing Workforce Survey. Journal of Nursing Regulation, 14(Suppl 2), S1–S90. doi:10.1016/S2155-8256(23)00047-9 [Google Scholar] [Crossref]

59. Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R. L., Reneau, K. A., … Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12(1 Suppl), S1–S96. doi:10.1016/S2155-8256(21)00027-2 [Google Scholar] [Crossref]

60. Smit, C., & Peddle, M. (2025). Experiences and perceptions of registered nurses in acute care regarding incident reporting: A scoping review. Healthcare, 13(11), 1250. doi:10.3390/healthcare13111250 [Google Scholar] [Crossref]

61. Sorra, J., Famolaro, T., Yount, N., & Smith, S. A. (2022). Hospital survey on patient safety culture: User’s guide (Version 2.0). Agency for Healthcare Research and Quality. https://www.ahrq.gov/sops/surveys/hospital/index.html [Google Scholar] [Crossref]

62. Tasbihi, M., Thomas, E. J., Etchegaray, J. M., & Singh, H. (2025). Differences in patient safety culture across hospital units: A cross-sectional study. BMJ Quality & Safety, 34(1), 56–64. https://doi.org/10.1136/bmjqs-2022-015064 [Google Scholar] [Crossref]

63. Wang, X., Liu, K., You, L. M., Xiang, J., Hu, H. G., & Zhang, L. F. (2021). Barriers to reporting adverse events in hospitals: A systematic review. Journal of Patient Safety, 17(8), e1465–e1475. https://doi.org/10.1097/PTS.0000000000000785 [Google Scholar] [Crossref]

64. Wawersik, D. M., Boutin, E. R., Gore, T., et al. (2023). Individual characteristics that promote or prevent psychological safety and error reporting in healthcare: A systematic review. Journal of Healthcare Leadership, 15, 59–70. doi:10.2147/JHL.S369242 [Google Scholar] [Crossref]

65. WTW. (2024). Just culture in healthcare: Moving from blame to learning. WTW Insights. https://www.wtwco.com [Google Scholar] [Crossref]

66. Yang, Y., & Liu, H. (2021). The effect of patient safety culture on nurses’ near-miss reporting intention. Journal of Research in Nursing, 26(1–2), 6–16. doi:10.1177/1744987120979344 [Google Scholar] [Crossref]

67. Yilmaz, A., Yildiz Keskin, A., & Sönmez, B. (2025). Nurses’ perceptions of patient safety culture and voice behaviors. Journal of Evaluation in Clinical Practice, 31(3), e70046. doi:10.1111/jep.70046 [Google Scholar] [Crossref]

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