Cultural influences on patient safety error responses among nursing students: A qualitative study

Patient safety is a fundamental component of nursing education and professional identity formation. Although safety culture is widely discussed in the literature, limited research has examined how international nursing students interpret and respond to patient safety issues within culturally diverse clinical learning environments. Understanding these perspectives is important for the development of culturally responsive patient safety education.

This study explored how cultural background shapes undergraduate nursing students' moral framing of patient safety, error attribution patterns, and responses to safety violations in clinical practice.

A descriptive qualitative design informed by phenomenological principles was employed. Participants were 25 international undergraduate nursing students enrolled in a four-year nursing programme in Türkiye and representing Middle Eastern, African, and European backgrounds. Data were collected through semi-structured interviews and analysed using Colaizzi's descriptive phenomenological method. Trustworthiness was supported through credibility, transferability, dependability, and confirmability strategies, including member checking, peer debriefing, and reflexive documentation.

Participants across all cultural groups expressed a shared ethical commitment to preventing harm and viewed patient safety as both a moral and professional obligation. However, differences emerged in error attribution and intervention behaviours. European participants more frequently emphasised system-level contributors, whereas Middle Eastern and African participants initially foregrounded personal responsibility and vigilance. Cultural meanings attached to hierarchy and authority influenced willingness to speak up, and ambivalence toward formal reporting reflected tensions between relational harmony and organisational transparency. Participants also identified theory-practice gaps, limited simulation exposure, and a need for culturally responsive patient safety education.

Patient safety behaviours among nursing students are shaped not only by curriculum content but also by culturally embedded moral and relational frameworks. Patient safety education should therefore integrate culturally responsive pedagogy, structured speaking-up practice, and explicit engagement with just culture principles to support safe practice in multicultural clinical learning environments.