Nurses' Perceptions of Patient Safety Culture in Intensive Care Units: A Systematic Review and Meta-Analysis

Intensive care units (ICUs) face heightened risks of adverse events.

This systematic review and meta-analysis synthesises global data on ICU nurses' perceptions of patient safety culture.

A systematic search was conducted in PubMed, Scopus, CINAHL and Web of Science for studies published between January 2005 and February 2025, using the Hospital Survey on Patient Safety Culture as the assessment tool. Observational studies reporting ICU nurses' perceptions of patient safety culture were included. Screening, data extraction and quality appraisal were performed independently by two reviewers, and pooled estimates were calculated using random-effects models with subgroup and meta-regression analyses to explore heterogeneity.

A total of 30 studies from 11 different countries involving 4029 ICU nurses were included. The subscale on 'teamwork within units' received the highest positive responses among ICU nurses (67.0%; [95% CI: 60.0-74.0]), followed by 'organisational learning-continuous improvement' (60.0%; [95% CI: 55.0-66.0]) and 'supervisor/manager expectations and actions promoting safety' (57.0%; [95% CI: 51.0-62.0]). The lowest reported patient safety culture was reported in 'nonpunitive response to error' (33.0%; [95% CI: 25.0-41.0]), followed by 'frequency of events reported' (41.0%; [95% CI: 35.0-48.0]) and 'staffing' (42.0%; [95% CI: 35.0-48.0]).

This review indicates that ICU nurses perceive teamwork positively, but report critical weaknesses in the culture of error reporting and staffing adequacy. These findings underscore the urgent need for targeted interventions to improve patient safety culture.

Managers should prioritise creating a nonpunitive reporting environment, optimising staffing ratios and fostering collaborative practices.