Promoting just culture in nursing education: A systematic integrative review on enhancing patient safety

Abstract

Background

Patient safety education is crucial in nursing to develop a culture of transparency, open communication, and learning from practice errors. A key component is ‘Just Culture,’ which shifts the focus from individual blame to system level accountability, fostering an environment where errors can be discussed without fear of punishment. Embedding these principles into nursing education helps shape future nurses' attitudes toward patient safety and supports the prevention of harm through continuous improvement. There is a need to integrate international knowledge about ‘Just Culture’ within nursing education.

Objective

To identify and explore the concept of ‘Just Culture’ within nursing education as perceived by nursing students, educators, and educational institutions.

Design

A systematic integrative review following Whitemore and Knafl's integrative method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Database search encompassed PubMed [including Medline], Scopus, CINAHL, ProQuest, Embase, Web of Science, and PsychInfo along with grey literature and hand searches were conducted with no time restrictions up to June 2024. A ‘framework for understanding the development of safety culture’ was used to identify, analyze, and synthesize the review findings narratively.

Results

The search led to 12 studies. To foster ‘Just Culture’ in nursing education, enabling factors are ‘prioritizing a blame-free environment’, ‘promoting critical thinking’, ‘open communication and learning’, and ‘actively engaging students in understanding safety events without fear of consequences’. Also, enacting behaviors involves ‘establishing safety reporting systems’, ‘promoting teamwork’, ‘integrating error reporting into the curriculum’, and ‘implementing follow-up processes to address safety incidents.’

Conclusions

Establishing ‘Just Culture’ in nursing education requires a blame-free environment that empowers students to report incidents without fear of repercussions. Also, educating and integrating standardized reporting tools into the curriculum and valuing student inputs are emphasized. Nurse educators and educational systems should promote transparency and open communication about practice errors leading to the improvement of safety culture and healthcare outcomes.