Just Culture on the Performance of Pediatric Nurses in a Government Hospital

Authors

Prescela Mariz C. Cedro, RN

Graduate School of Allied Health Sciences, University of the Visayas (Philippines)

Joan P. Bacarisas, DM, MAN, RN

Graduate School of Allied Health Sciences, University of the Visayas (Philippines)

Article Information

DOI: 10.51584/IJRIAS.2026.110400172

Subject Category: Health Science

Volume/Issue: 11/4 | Page No: 2227-2242

Publication Timeline

Submitted: 2026-04-20

Accepted: 2026-04-25

Published: 2026-05-18

Abstract

This study utilized a quantitative descriptive–correlational research design to assess the level of just culture and nursing work performance, and to determine whether the dimensions of just culture predict nursing performance in a pediatric unit of a government hospital. A total of 67 nurses participated in the study using validated questionnaires measuring just culture and nursing work performance in terms of frequency and quality. Descriptive statistics, including mean and standard deviation, were used to determine levels of just culture and performance, while multiple regression analysis was used to examine predictive relationships. Findings revealed that nurses perceived a high level of just culture across organizational trust, openness of communication, quality of event reporting, accountability, and continuous learning, while fear of reporting was moderate. Nursing work performance was high in terms of both frequency and quality. However, regression analysis showed that the dimensions of just culture did not significantly predict nursing performance. This indicates that nurses maintained consistent and quality performance regardless of variations in perceived just culture. The findings suggest that just culture supports a safe and fair work environment, while nursing performance is primarily sustained by professional competence, clinical standards, and organizational systems. A Just Culture and Nursing Performance Enhancement Plan is proposed to strengthen patient safety culture and sustain high-quality nursing care.

Keywords

Just Culture; Nursing Performance; Pediatric Nurses

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References

1. Ahsan, A., Setiowati, L., Noviyanti, L. W., Rahmawati, I. N., Ningrum, E. H., & Putra, K. R. (2021). Nurses’ team communication in hospitals: A quasi-experimental study using a modified TeamSTEPPS. Journal of Public Health Research, 10(2), 197–201. doi:10.4081/jphr.2021.2157 [Google Scholar] [Crossref]

2. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., & Griffiths, P. (2017). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. International Journal of Nursing Studies, 74, 1–9. [Google Scholar] [Crossref]

3. Al Ma’mari, Q., Sharour, L. A., & Al Omari, O. (2020). The impact of safety culture on nurses’ patient safety performance. Journal of Nursing Management, 28(8), 1963–1970. https://doi.org/10.1111/jonm.13160 [Google Scholar] [Crossref]

4. Al Sabei, S. D., & Lasater, K. (2016). The influence of nursing work environment and patient safety culture on nurse performance and patient outcomes: A systematic review. Journal of Nursing Care Quality, 31(4), 341–349. [Google Scholar] [Crossref]

5. Alibudbud, R. C. (2023). Burnout, depression, anxiety, and stress among Filipino nurses during the COVID-19 pandemic: Implications for policy and practice. Belitung Nursing Journal, 9(2), 107–112. [Google Scholar] [Crossref]

6. Alquwez, N. (2023). Examining the influence of leadership support and organizational trust on nurses’ patient safety culture. Healthcare, 11(3), 345. https://doi.org/10.3390/healthcare11030345 [Google Scholar] [Crossref]

7. Alsabri, M., Boudi, Z., Lauque, D., Dias, R. D., Whelan, J. S., Östlundh, L., et al. (2022). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: A systematic review. Journal of Patient Safety, 18(1), E351–E361. https://doi.org/10.1097/PTS.0000000000000782 [Google Scholar] [Crossref]

8. Alsadaan, N., Jones, L. K., Kimpton, A., & DaCosta, C. (2023). Impact of nurse leaders’ behaviors on nursing staff performance: A systematic review of literature. Nursing Administration Quarterly, 47(2), 98–110. https://doi.org/10.1097/NAQ.0000000000000576 [Google Scholar] [Crossref]

9. Alshahrani, F. M., Baig, M., Alshahrani, A., & Alqarni, M. S. (2022). Perceptions of just culture among nurses and its impact on patient safety culture: A cross-sectional study. Journal of Nursing Management, 30(4), 1023–1031. https://doi.org/10.1111/jonm.13562 [Google Scholar] [Crossref]

10. Alshammari, F., Pasay-an, E., & Gonzales, F. (2021). Nurses’ perceptions of patient safety culture and reporting systems. International Journal of Nursing Practice, 27(1), e12882. https://doi.org/10.1111/ijn.12882 [Google Scholar] [Crossref]

11. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA Publishing. [Google Scholar] [Crossref]

12. Atalla, G., Alhassan, M., & Bakr, M. (2025). Just culture and nurses’ organizational commitment: The mediating role of moral sensitivity. Journal of Nursing Management, 33(1), 45–53. [Google Scholar] [Crossref]

13. Badran, F. M. M., Khalifa, M. a. E. R. G., Elghannam, H. M., & Ali, E. H. M. (2026). From blame to learning: implementing a just culture program for head nurses and its impact on silent behavior and error reporting among staff nurses. BMC Nursing, 25(1), 96. https://doi.org/10.1186/s12912-025-04265-5 [Google Scholar] [Crossref]

14. Baek, H., Han, K., Cho, H., & Ju, J. (2023). Nursing teamwork is essential in promoting patient-centered care: A cross-sectional study. BMC Nursing, 22, 433. doi:10.1186/s12912-023-01592-3 [Google Scholar] [Crossref]

15. Baek, H., Han, K., Ryu, J., & Hwang, J. I. (2023). Nursing teamwork is essential in promoting patient-centered care: A cross-sectional study. BMC Nursing, 22, 433. https://doi.org/10.1186/s12912-023-01592-3 [Google Scholar] [Crossref]

16. Boyer, L., Wu, A. W., Fernandes, S., Tran, B., Brousse, Y., Nguyen, T. T., Yon, D. K., Auquier, P., Lucas, G., Boussat, B., & Fond, G. (2024). Exploring the fear of clinical errors: associations with socio-demographic, professional, burnout, and mental health factors in healthcare workers – A nationwide cross-sectional study. Frontiers in Public Health, 12, 1423905. https://doi.org/10.3389/fpubh.2024.1423905 [Google Scholar] [Crossref]

17. Building a Culture of Safety in Healthcare, Part Four: Just Culture. (2023). Thedoctors.com. https://www.thedoctors.com/the-doctors-advocate/second-quarter-2023/building-a-culture-of-safety-in-healthcare-part-four-just-culture/ [Google Scholar] [Crossref]

18. Cherry, B., & Jacob, S. R. (2019). Contemporary nursing: Issues, trends, and management (8th ed.). Elsevier. [Google Scholar] [Crossref]

19. Daba, L., Bekele, M., & Getahun, T. (2024). Job performance and associated factors among nurses working in public hospitals. BMC Nursing, 23, Article 1979. https://doi.org/10.1186/s12912-024-01979-w [Google Scholar] [Crossref]

20. Davis, K. G., Marinucci, A., & Gurses, A. P. (2021). The impact of organizational resources and staffing on nursing performance: A cross-sectional study. BMC Nursing, 20, 245. [Google Scholar] [Crossref]

21. Davis, T. R., Straatmann, K., Snyder, N., Shiner, D., Evans, A., Caruso, C., & Alton, M. (2025). Promoting a culture of patient safety: Using the principles of just culture to improve transparency and risk reporting in the hospital setting. Patient Safety, 7(2). https://doi.org/10.33940/001c.137737 [Google Scholar] [Crossref]

22. Dekker, S., & others. (2022). Fostering a just culture in healthcare organizations: Experiences in practice. BMC Health Services Research, 22, Article 1035. [Google Scholar] [Crossref]

23. Diab, A., Samia, Mohsen, A., Faygah Shibily, Ohood Felemban, Makiah Mohammed Shebaili, Mostafa, W. H., Mohamed, Sayed, M., Mohammad, M. Z., & Sobhi, M. (2025). Exploring how organizational virtuousness shapes nurses’ occupational commitment: the mediating role of just culture. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-03835-x [Google Scholar] [Crossref]

24. Edwards, M. T., Smith, A. D., & Zhang, J. (2021). The influence of just culture on quality and safety outcomes in healthcare organizations. Journal of Patient Safety, 17(8), e1551–e1557. [Google Scholar] [Crossref]

25. El-Sayed, B. K. M., Asal, M. G., Abdelaliem, S. M., Alsenany, S. A., & Elsayed, B. K. (2025). Insights from critical care nurses: Role of leadership coaching in enhancing incident reporting culture: A cross-sectional study. BMC Nursing, 24, Article 3791. https://doi.org/10.1186/s12912-025-03791-6 [Google Scholar] [Crossref]

26. Ernstmeyer, K., & Christman, E. (2021). Scope of practice. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK591808/ [Google Scholar] [Crossref]

27. Glarcher, M., & Vaismoradi, M. (2025). Promoting just culture in nursing education: A systematic integrative review on enhancing patient safety. Nurse Education Today, 152, 106776–106776. https://doi.org/10.1016/j.nedt.2025.106776 [Google Scholar] [Crossref]

28. Go, E. C., Serad, J. B., Bacarisas, J. P., Amores, E. A., & Picardo, R. L. (2025). Clinical Competence on Patient Care Quality with Workplace Support as Mediator among Nurses. International Journal of Research and Scientific Innovation, XII(VI), 358–385. https://doi.org/10.51244/ijrsi.2025.12060030 [Google Scholar] [Crossref]

29. Hakvoort, L., Kusurkar, R. A., Hulsman, R. L., & Scherpbier, A. (2022). Factors that influence continuing professional development of nurses: A systematic review. Nurse Education Today, 117, 105484. https://doi.org/10.1016/j.nedt.2022.105484 [Google Scholar] [Crossref]

30. Hamdan, M., Jaaffar, A. H., Khraisat, O., Issa, M. R., & Jarrar, M. T. (2024). The association of transformational leadership on safety practices among nurses: The mediating role of patient safety culture. Risk Management and Healthcare Policy, 17, 1687–1700. https://doi.org/10.2147/RMHP.S458505 [Google Scholar] [Crossref]

31. Han, N., Jeong, S. H., Lee, M. H., & Kim, H. S. (2024). Impacts of just culture on perioperative nurses’ attitudes and behaviors with regard to patient safety incident reporting: Cross-sectional nationwide survey. Asian Nursing Research. https://doi.org/10.1016/j.anr.2024.09.001 [Google Scholar] [Crossref]

32. Han, N., Jeong, S. H., Lee, M. H., & Kim, H. S. (2024). Impacts of just culture on nurses’ patient safety behaviors. Asian Nursing Research. https://doi.org/10.1016/j.anr.2024.09.001 [Google Scholar] [Crossref]

33. Han, N., Seok Hee Jeong, Myung Ha Lee, & Hee Sun Kim. (2024). Impacts of just culture on perioperative nurses’ attitudes and behaviors with regard to patient safety incident reporting: Cross-sectional nationwide survey. Asian Nursing Research, 18(4). https://doi.org/10.1016/j.anr.2024.09.001 [Google Scholar] [Crossref]

34. Hassan, A. E., (et al.). (2024). Evaluating the effect of TeamSTEPPS on teamwork perceptions and patient safety culture among newly graduated nurses. BMC Nursing, 23, (Article). doi:10.1186/s12912-024-01850-y [Google Scholar] [Crossref]

35. Hendy, A., (et al.). (2025). Bridging the gap: The mediating role of self-efficacy in the impact of workload on core competencies among pediatric nurses. BMC Nursing, 24, 956. doi:10.1186/s12912-025-03522-x [Google Scholar] [Crossref]

36. Jeong, S. (2025). Work environment and nursing performance. Journal of Nursing Management. https://doi.org/10.1111/jonm.14235 [Google Scholar] [Crossref]

37. Kim, B. B., & Yu, S. (2021). Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses. Healthcare, 9(10), 1324. https://doi.org/10.3390/healthcare9101324 [Google Scholar] [Crossref]

38. Kim, Y., & Lee, E. (2022). Effects of just culture on safety activities and error reporting among nurses. Journal of Nursing Scholarship, 54(4), 456–464. https://doi.org/10.1111/jnu.12743 [Google Scholar] [Crossref]

39. Koskiniemi, S., et al. (2025). Patient safety reporting systems and nursing performance. Journal of Advanced Nursing. https://doi.org/10.1111/jan.16364 [Google Scholar] [Crossref]

40. Labrague, L. J., McEnroe-Petitte, D. M., & Tsaras, K. (2020). Predictors and outcomes of nurse professional competence: A systematic review and meta-analysis. Journal of Nursing Scholarship, 52(2), 200–210. https://doi.org/10.1111/jnu.12544 [Google Scholar] [Crossref]

41. Lee, S. E., & Dahinten, V. S. (2021). Psychological safety and error reporting in healthcare. Journal of Advanced Nursing, 77(6), 2512–2521. https://doi.org/10.1111/jan.14791 [Google Scholar] [Crossref]

42. Liu, Y., Lee, A., & Chen, W. (2023). Organizational support and job performance among nurses: The mediating role of professional development opportunities. Journal of Nursing Management, 31(2), 305–314. [Google Scholar] [Crossref]

43. Logroño, K. J., Al‐Lenjawi, B., Singh, K., & Alomari, A. (2023). Assessment of nurse’s perceived just culture: a cross-sectional study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01478-4 [Google Scholar] [Crossref]

44. Maha Subih, Rasmieh Al-Amer, Enas, & Imad Numan Thultheen. (2024). Predictors of Clinical Performance Among Emergency Nurses: A Cross-Sectional Study. SAGE Open Nursing, 10. https://doi.org/10.1177/23779608241281468 [Google Scholar] [Crossref]

45. Marx, D. (2001). Patient safety and the “Just Culture”: A primer for health care executives. New York: Columbia University. [Google Scholar] [Crossref]

46. Morales, M., & Estioko, E. (2020). Perceptions of Nurse Managers on Patient Safety Culture and Safety Culture Maturity Level of Selected Internationally Accredited Hospitals in Metro Manila, Philippines. Asia Pacific Journal of Academic Research in Social Sciences, 5(2), 8–17. https://research.lpubatangas.edu.ph/wp-content/uploads/2020/12/APJARSS-2020-5-002.pdf [Google Scholar] [Crossref]

47. Murray, J. S., Clifford, J., Larson, S., Lee, J. K., & Sculli, G. L. (2022). Implementing just culture to improve patient safety. Military Medicine, 188(7–8), 1596–1599. https://doi.org/10.1093/milmed/usac115 [Google Scholar] [Crossref]

48. Ndirangu-Mugo, E. (2024). Psychological safety. Nurse Leader, 23(1), 82–86. https://doi.org/10.1016/j.mnl.2024.10.012 [Google Scholar] [Crossref]

49. O’Donovan, R., & McAuliffe, E. (2020). Exploring psychological safety in healthcare teams. BMC Health Services Research, 20, 101. https://doi.org/10.1186/s12913-020-4932-0 [Google Scholar] [Crossref]

50. Ominyi, J., & Alabi, A. (2025). Promoting evidence-based nursing through collaboration, autonomy, and agency: A qualitative case study. International Journal of Nursing Sciences. Advance online publication. doi: 10.1016/j.ijnss.2025.08.010 [Google Scholar] [Crossref]

51. 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(1), 231. https://doi.org/10.1186/s12912-023-01376-9 [Google Scholar] [Crossref]

53. Paradiso, L. A., & Sweeney, N. (2017). The Relationship Between Just Culture, Trust and Patient Safety. Publications and Research. https://academicworks.cuny.edu/ny_pubs/161/ [Google Scholar] [Crossref]

54. Petschonek, S., Burlison, J., Cross, C., Martin, K., Laver, J., Landis, R. S., & Hoffman, J. M. (2013). Development of the Just Culture Assessment Tool (JCAT): Measuring the perceptions of health care professionals in hospitals. Journal of Patient Safety, 9(4), 190–197. [Google Scholar] [Crossref]

55. Pfeifer, L., Vessey, J., Cazzell, M., Ponte, P. R., & Geyer, D. (2023). Relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing. Journal of Pediatric Nursing, 73, 130–136. https://doi.org/10.1016/j.pedn.2023.09.001 [Google Scholar] [Crossref]

56. Pfeifer, L., Vessey, J., Cazzell, M., Ponte, P. R., & Geyer, D. (2023). Psychological safety and pediatric nursing performance. Journal of Pediatric Nursing, 73, 130–136. https://doi.org/10.1016/j.pedn.2023.09.001 [Google Scholar] [Crossref]

57. Rodríguez-García, M. C., Gutiérrez-Puertas, L., Barrientos-Trigo, S., & Romero-Sánchez, J. M. (2022). The impact of just culture on nurses’ job satisfaction and patient safety: A systematic review. International Journal of Environmental Research and Public Health, 19(4), 2134. [Google Scholar] [Crossref]

58. Schwirian, P. M. (1978). Evaluating the performance of nurses: The six-dimension scale of nursing performance. Nursing Research, 27(6), 347–352. [Google Scholar] [Crossref]

60. Sharif, N., Al-Ghamdi, S., & Moustafa, M. (2022). Ethical climate, moral courage, and vocational commitment among nurses in acute care settings. BMC Nursing, 21(1), 221. [Google Scholar] [Crossref]

61. Singh, S., & Zayapragassarazan, Z. (2023). Just culture in healthcare: Moving towards a culture of safety and accountability. International Journal of Health Sciences, 17(1), 54–62. https://doi.org/10.53730/ijhs.v17n1.19254 [Google Scholar] [Crossref]

62. Vaismoradi, M., Griffiths, P., Turunen, H., & Jordan, S. (2020). Transformational leadership in nursing and medication safety education: A discussion paper. Journal of Nursing Management, 28(6), 1170–1178. [Google Scholar] [Crossref]

63. Välimäki, M., Hu, S., Lantta, T., Hipp, K., Varpula, J., Chen, J., Liu, G., Tang, Y., Chen, W., & Li, X. (2024). The impact of evidence-based nursing leadership in healthcare settings: A mixed methods systematic review. BMC Nursing, 23, 452. doi:10.1186/s12912-024-02096-4 [Google Scholar] [Crossref]

64. Vifladt, A., Simonsen, B. O., Lydersen, S., & Farup, P. G. (2021). The association between patient safety culture and nurse performance in hospitals: A cross-sectional study. Boysen, P. G. (2013). Just culture: A foundation for balanced accountability and patient safety. Ochsner Journal, 13(3), 400–406. [Google Scholar] [Crossref]

65. Vogus, T. J., & Hilligoss, P. B. (2021). The underpinnings of a just culture in healthcare. Annual Review of Organizational Psychology and Organizational Behavior, 8, 353–377. https://doi.org/10.1146/annurev-orgpsych-012420-055340 [Google Scholar] [Crossref]

66. Wachter, R. M., & Pronovost, P. J. (2009). Why accountability sharing in health care organizational cultures means patients are probably safer. AMA Journal of Ethics, 22(9), 771–778. [Google Scholar] [Crossref]

67. Wang, X., Liu, K., & You, L. (2022). Patient safety culture and its relationship with nurse performance. Journal of Nursing Care Quality, 37(2), 145–152. https://doi.org/10.1097/NCQ.0000000000000582 [Google Scholar] [Crossref]

68. World Health Organization. (2021). Patient safety incident reporting and learning systems: Implementation guidance. World Health Organization. [Google Scholar] [Crossref]

69. World Health Organization. (2023, September 11). Patient safety. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/patient-safety [Google Scholar] [Crossref]

70. Yoon, J., & Kim, M. (2020). Determinants of nursing performance: A structural equation modeling approach. Journal of Advanced Nursing, 76(8), 2124–2134. [Google Scholar] [Crossref]

71. Yu, X., Huang, Y., & Liu, Y. (2022). Nurses’ perceptions of continuing professional development: A qualitative study. BMC Nursing, 21, 162. https://doi.org/10.1186/s12912-022-00940-z [Google Scholar] [Crossref]

72. Yuxiu, P., Kunaviktikul, W., & Thungjaroenkul, P. (2011). CMU. J. Nat. Sci, 10(2). https://www.thaiscience.info/Journals/Article/CMUJ/10824135.pdf [Google Scholar] [Crossref]

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