Breaking the Silence: A Mixed-Methods Study of Barriers and Solutions to Incident Reporting in Critical Care Units

Incident reporting is a cornerstone of patient safety, particularly in critical care settings where patients are highly vulnerable to adverse events. Despite international efforts to promote safety reporting, underreporting persists, especially in low- and middle-income countries. Nurses, as frontline providers, are central to detecting and reporting incidents; however, psychological, organizational, and cultural factors often limit their engagement in reporting processes.

To explore barriers to incident reporting among nurses working in critical care units and identify nurse-informed solutions to strengthen reporting practices and patient safety culture.

A convergent mixed-methods design was employed. A convenience sample of 251 critical care nurses was recruited from eight critical care units of a university hospital. Quantitative data were collected using the researcher-developed Incident Reporting Survey (IRS), which underwent content validation and reliability testing. Descriptive statistics, t-tests, ANOVA, correlation analysis, and multiple linear regression were performed using SPSS version 23. Qualitative data were obtained through two open-ended survey questions and analyzed using Braun and Clarke's thematic analysis framework. Quantitative and qualitative findings were integrated during interpretation through triangulation to generate a comprehensive understanding of reporting barriers and potential solutions.

Nurses reported limited awareness of reporting procedures and reluctance to submit reports. Major barriers included fear of blame and punishment, lack of anonymity, heavy workload, inadequate training, and limited managerial support. Qualitative findings reinforced these issues and further highlighted concerns about professional reputation, ineffective feedback mechanisms, and complex reporting systems.

Incident reporting remains insufficient due to interconnected individual and organizational barriers. Cultural, educational, and system-level interventions-particularly non-punitive policies and leadership support-are essential to enhance reporting behaviors and strengthen patient safety outcomes.