Journal of Patient Safety最新文献

{"title":"Incidence of and Risk Factors for Repeat Adverse Drug Events: A Systematic Review.","authors":"Chris Niosco, Christina Lam, Terri Ser, Amber Cragg, Arnold Okpani, Kira Gossack-Keenan, Corinne M Hohl","doi":"10.1097/PTS.0000000000001490","DOIUrl":"10.1097/PTS.0000000000001490","url":null,"abstract":"<p><p>Adverse drug events (ADEs) are unintended harm resulting from appropriate or inappropriate medication use. Many ADE-related emergency department visits are repeat events that occur after re-exposure to a medication that previously caused harm. Identifying risks and risk factors for repeat ADEs could inform clinical decision-making. We conducted a systematic review of literature on repeat ADEs published over a 20-year period. We applied a predefined search strategy in MEDLINE, Embase, and Scopus and extracted data on risk factors (e.g., age, sex, drug type, re-exposure type) and ADE outcomes. We conducted a meta-analysis if 2 or more studies reported on the same drug class, re-exposure type, ADE outcome, and follow-up period. We screened 13,452 articles and included 55. Most studies reported on re-exposures to the same drug (n=44), with few reporting on exposures to new drugs (n=5). The most studied drug classes were antineoplastics (n=20), anticoagulants (n=10), and antibiotics (n=5). The proportion of Repeat ADEs varied widely across studies from <1 to 88%. We were only able to pool data from studies on re-exposure to anticoagulants and found that 10% (95% confidence interval: 4%-19%) rebled within 90 days. Repeat ADE risks varied by drug class, reflecting different patient populations, medications and indicating conditions. Inconsistent reporting prevented quantification of risk factors. Pooled repeat ADE incidence, where available, can inform shared decision-making by providing estimates of ADE risk in the context of re-exposures to treat underlying conditions. Repeat ADEs remain an understudied area, highlighting the need for further research given their clinical significance.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"418-432"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental Dialysis Catheter Cut due to a Strongly Adhesive Dressing Material.","authors":"Tatsuo Tsukamoto, Asato Makise, Miho Miyauchi, Kaoru Ohue, Takaya Handa, Yasuko Tsuchiya, Mayumi Masuda, Yoshiki Tsuji, Yuko Sokai, Takeshi Matsubara","doi":"10.1097/PTS.0000000000001562","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001562","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety Signals in Telehealth Primary Care and Outpatient Settings: Incident and Reporting Analysis Using World Health Organization Classification.","authors":"Gabriela B Togashi, Douglas P Silva, Camila N Monteiro, Bárbara M Lima, Daiane A Dias, Alessandra M Campos-Staffico","doi":"10.1097/PTS.0000000000001553","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001553","url":null,"abstract":"<p><strong>Objectives: </strong>Patient safety in primary health care remains understudied compared with hospital settings, with particularly scarce comparative evidence on incident profiles across outpatient and telehealth modalities. This study addresses these gaps by characterizing safety signals and reporting dynamics in a Brazilian supplementary health program.</p><p><strong>Methods: </strong>This observational, retrospective study analyzed incident notifications from an institutional reporting system (January 2019 to October 2024), adhering to EQUATOR and STROBE guidelines. Incidents were classified using the World Health Organization International Classification for Patient Safety. Distributions of incident types, harm severity, reporter categories, and adverse events between outpatient and telehealth settings were compared using the χ2 or Fisher exact tests, with associations quantified through univariable logistic regression as odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Among 3,287 incidents, telehealth reports were dominated by infrastructure (46.0%) and behavioral (36.0%) issues, while outpatient reports emphasized clinical processes/procedures (25.7%) and medication events (17.8%; P<0.001). Telehealth reports were more concentrated in risk circumstances and less often classified as near misses, incidents without harm, mild adverse events, or adverse events, with no significant difference in moderate or severe adverse events. Nurses submitted significantly more telehealth than outpatient reports (85.1% vs. 38.3%; P<0.001).</p><p><strong>Conclusion: </strong>Telehealth and outpatient primary care have distinct safety profiles shaped by differences in incident type, report behavior, and care context. A one-size-fits-all approach is inadequate -while institutional interventions can quickly shift reporting culture, lasting improvement requires modality-specific strategies. Policymakers should adopt tailored safety frameworks for both virtual and outpatient care to translate reporting gains into real harm reduction.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Communication Response Latency as an Operational Efficiency and Patient Safety Indicator in Acute Care Hospitals.","authors":"Ashish Kumar Singh","doi":"10.1097/PTS.0000000000001577","DOIUrl":"10.1097/PTS.0000000000001577","url":null,"abstract":"<p><strong>Objectives: </strong>Timely clinical communication is a core safety function in acute care, yet response latency remains poorly measured. This study treats it as a stratified safety indicator and introduces a dual-phase model distinguishing verbal triage (T₀verbal) from physical intervention (T₀physical).</p><p><strong>Methods: </strong>A mixed-methods observational design evaluated nurse call response latency across 3 anonymised hospitals: Hospital A (public, no-voice), Hospital B (private, no-voice), and Hospital C (private, voice-enabled). Voice-enabled systems provide 2-way audio between the patient and the nurse before arrival. A total of 16,000 call events across 9 departments were stratified by shift and acuity (NEWS2). Semistructured interviews contextualised patterns within the SEIPS 2.0 framework. Escalation was defined as a response time exceeding 180 seconds.</p><p><strong>Results: </strong>Median response times were 29 seconds (voice-enabled), 130 seconds (private nonvoice), and 256 seconds (public nonvoice). The 90th-percentile response times were 60, 381, and 416 seconds, respectively. Escalation rates were 0.0%, 19.6%, and 70.3%. Ward night shift escalation in hospital A reached 76.0%. For patients with NEWS2 ≥7, medians were 28 seconds (voice-enabled) versus 80 to 88 seconds (nonvoice). Qualitative themes identified alarm fatigue, nonvalue-added locomotion, and coordination friction.</p><p><strong>Conclusions: </strong>Response latency, including tail latency, shift-stratified escalation, and the Surveillance Gap in nonvoice environments, may function as a leading indicator for safety monitoring. Voice-enabled communication may support workflow during low-staffing hours by narrowing the verbal-to-physical intervention interval and reducing nonvalue-added nursing locomotion. Findings are associative; institution type and communication modality were not fully separable.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Likelihood of Experiencing a Pediatric Safety Event in the Inpatient Setting.","authors":"Senayit Demie, Jennifer Lee, Katharine Cunnane, Sarah Rosselli, Anjile An, Joy Howell, Erika Abramson, Snezana Nena Osorio","doi":"10.1097/PTS.0000000000001578","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001578","url":null,"abstract":"<p><strong>Objective: </strong>Adult studies show that persons marginalized by race/ethnicity, preferred language, and public insurance experience higher rates of hospital harm. This study examined the association between patient race/ethnicity, preferred language, insurance type, and safety events among hospitalized pediatric patients.</p><p><strong>Methods: </strong>This retrospective observational study analyzed safety event reports from 2 tertiary children's hospitals (2020-2022). Patients ≤18 years admitted to neonatal intensive care, pediatric intensive care, and inpatient units were included. Demographics were obtained from the electronic health record, and safety events from the voluntary reporting system. Patients were matched by age, sex, and unit to reduce confounding. Descriptive statistics and multivariable logistic regression were used to assess the independent effect of demographic factors on the occurrence of safety events.</p><p><strong>Results: </strong>Among 4112 unique patients, 370 (9%) experienced a reported safety event. Medication errors comprised 76% of events. After matching, there were no statistically significant differences in the likelihood of experiencing a safety event by race/ethnicity or primary language. However, patients with public insurance had higher odds of experiencing a safety event than those with private insurance (OR=1.51; 95% CI: 1.04-2.20).</p><p><strong>Conclusion: </strong>Public insurance type remains a significant factor in a patient's likelihood of experiencing a safety event during hospitalization. While previous studies have identified race/ethnicity and primary language as contributing factors, we observed no such associations in our analysis. Further research is warranted to explore the underlying structural drivers of this health inequity.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nationwide Descriptive Epidemiological and Text-mining Analysis of Incidents and Adverse Events Involving Clinical Engineers in Japan.","authors":"Ryo Sato, Keizo Wauchi, Hirohito Imada","doi":"10.1097/PTS.0000000000001567","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001567","url":null,"abstract":"<p><strong>Objectives: </strong>Although clinical engineers (CEs) play essential roles in medical device safety management, analyses of CE-related safety events remain limited. This nationwide study characterizes CE-involved incidents and adverse events and identifies priority areas for improvement.</p><p><strong>Methods: </strong>From 162,837 Japan Council for Quality Health Care patient safety reports (2010-2024), CE-related reports were retrieved by keyword searches across all columns and deduplicated by ID. Incidents were defined as events with no, minor, or unknown patient impact, whereas adverse events involved death, residual disability, or unexpected treatment beyond what had been anticipated. Two reviewers independently screened free-text descriptions to confirm CE involvement, and any discrepancies were resolved by a third reviewer. The final data set comprised 1845 CE-involved reports: 1484 incidents and 361 adverse events. Descriptive statistics and text mining were applied.</p><p><strong>Results: </strong>Cases were reported on weekdays in dialysis rooms, operating rooms, and intensive care units. Male patients were affected in 65.8% of incidents and 59.8% of adverse events; patients aged 70 to 79 years were most affected. Incidents most often involved CEs with 0 to 4 years' experience (35.2%); adverse events, those with 5 to 9 years' experience (29.1%). Co-occurrence network analysis identified clusters centered on multidisciplinary collaboration and device operation (case descriptions), verification and device setup (contributing factors), and verification and inspection (improvement measures).</p><p><strong>Conclusions: </strong>Reported CE-related events most frequently involved elderly male patients and early-career CEs, with recurring vulnerabilities in device setup, connection, and verification. Rather than relying on human vigilance, prevention requires workflow standardization, technology-assisted verification, and supervision of junior staff.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Provider Perspectives on Efficiency and Patient Safety With Paper and Digital Tools for Handoffs of Patient Care.","authors":"O Agata Walkowiak, Meredith Pavicic, Quetzal A Class","doi":"10.1097/PTS.0000000000001574","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001574","url":null,"abstract":"<p><strong>Objectives: </strong>Handoffs of patient care are opportunities for promoting efficiency and safety. With the shift from paper to digital records, we examine changes in provider perceptions of efficiency, errors, and confidence on a labor and delivery service at an urban, academic hospital.</p><p><strong>Methods: </strong>An anonymous survey was sent during the use of a paper and digital handoff board. Descriptive statistics and χ2 analyses were used to compare provider perceptions.</p><p><strong>Results: </strong>Survey responders were primarily resident (50.0%-54.8%) and attending (35.5%-50.0%) physicians, as well as one certified nurse-midwife. Responders' training levels did not differ significantly [χ2 (2)=2.61, P=0.27]. Time spent updating the board did not differ significantly [χ2 (4)=3.50, P=0.48], although there were fewer delays in initiating the handoff [χ2 (3)=27.03, P<0.001] when using a digital board. Providers reported fewer errors [χ2 (5)=18.26, P<0.01], and perception of patient safety was greater with the digital board [χ2 (4)=10.07, P <0.05]. Providers reported higher scores on the standardization of patient presentation [χ2 (4)=17.95, P=0.001] and greater ease of updating the records [χ2 (4)=20.75, P <0.001] with the digital board.</p><p><strong>Conclusions: </strong>Compared with provider perceptions of using a paper board, providers reported improved scores in efficiency, errors, safety, and standardization of patient presentation when using a digital board. Our findings document the benefit of transitioning to digital tools to facilitate handoffs, especially in a fast-paced labor and delivery setting.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Serious Reportable and Sentinel Events Within Psychiatric Inpatient Settings-A Scoping Review.","authors":"Jing Ling Tay, Ting Wang, Ziqiang Li","doi":"10.1097/PTS.0000000000001575","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001575","url":null,"abstract":"<p><p>Serious reportable and sentinel events are preventable events that cause death or serious injuries to patients. Such events within the field of psychiatry include abscondment, inpatient suicide, unexpected deaths, sexual assaults, and serious physical assaults. This review aimed to examine the contributing risk factors and preventive strategies of serious reportable or sentinel events. PRISMA for scoping reviews and the updated Arksey and O'Malley methodological framework for conducting scoping reviews guided the methodology of the review. Databases (CINAHL, Embase, PsycINFO, PubMed, ScienceDirect, and Scopus) were searched. Twenty-nine articles were included. The articles explored (1) inpatient suicide [n=18 (62.07%)]; (2) general adverse events [n=5 (17.24%)]; (3) serious assaults [n=2 (6.90%)]; (4) abscondment [n=2 (6.90%)]; and (5) inpatient sexual events [n=2 (6.90%)]. Preventive strategies were as follows: (1) suicide (means restriction, allocation of high‑risk patients to higher‑dependency wards, safe prescribing, psychiatrist review of high-risk patients around the clock); (2) unexpected death (routine medical review, prompt activation of the code blue team); and (3) sexual incidents (segregation of genders). Consistent preventive strategies common to all adverse events, including establishment and continual review of guidelines, optimal staffing, and training, a secured ward with surveillance and no blind spots, rigorous observation, individualized risk assessments, and supportive counseling to patients. Consistent factors were associated with varying serious reportable or sentinel events. These factors were associated with patient and ward profiles, management, staffing, training, observation, risk assessments, and treatment. Bolstering factors related to the prevention of these events can enhance patient safety and the provision of quality care for psychiatric inpatients.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Randomized Controlled Simulation Study to Test a Proof-of-Concept Real-Time Periprocedural Decision Support System to Aid in Timely Diagnosis and Intervention on Patient Deterioration.","authors":"Anthony Dinkel, Justin Talluto, Vikranth Chinthareddy, Kevin McCarthy, Dolly Vijaykumar, Steven B Greenberg, Andrew R Locke, Claire Heshmat, Nathan Huey, Stacey Ellender, Fred E Shapiro","doi":"10.1097/PTS.0000000000001573","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001573","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The recent pilot simulation study by Greenberg and colleagues introduced a proof-of-concept audio-visual support system for anesthesiology professional management of perioperative patient deterioration. The results demonstrated that real-time decision support for providers may enhance diagnostic accuracy/efficiency. In collaboration with Greenberg and colleagues, the authors from Massachusetts General Brigham (MGB) similarly developed a realistic operating room simulation environment at Massachusetts General Hospital (MGH) Learning Center. Here, the ability of anesthesiology trainees to accurately diagnose and treat using audio-visual cues was measured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a prospective, randomized controlled pilot trial adapted from a recent study further investigating the impact of audio-visual decision support on anesthesiology resident and student nurse anesthetist diagnostic accuracy and efficiency. This study took place entirely at Massachusetts General Hospital Center for Simulation and Innovation. Twenty-one anesthesiology trainees were randomized into 2 groups: (1) standard of care (control) versus (2) audio-visual cue group (experimental). The experimental group received audio-visual cues such as a choice of possible diagnoses from an experienced anesthesiologist and subsequent recommended interventions from the Stanford emergency manual and based on changes in the simulated patient's vitals. Each participant underwent 3 experimental simulations where patient deterioration occurs. These included: anaphylaxis, amniotic fluid embolism (AFE), and pulseless electrical activity (PEA) arrest during a pediatric dental case. Key time points and accuracy of diagnoses and treatment steps were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The simulation scenario recordings for 10 anesthesiology residents and 11 student nurse anesthetists of various training years were investigated. For the anaphylaxis scenario, there was a statistically significant increase in the number of participants who correctly executed intervention 1 in the intervention group compared with the control group (P=0.0015). For the AFE scenario, there was a statistically significant increase in the median time to intervention 1 for SRNAs in the intervention group compared with the control group (P=0.01). However, there was a statistically significant decrease in the median time to intervention 1 for residents in the intervention group compared with the control group (P=0.01). For the pediatric dental scenario, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 2 (P=0.005). In addition, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 3 (P=0.023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results indicate that real","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Nursing Work Environment, Ethical Leadership, and Organizational Communication on General Hospital Nurses' Perception of Just Culture: A Cross-Sectional Study.","authors":"Eun Hye Kim, Soyoung Yu, Yea Seul Yoon","doi":"10.1097/PTS.0000000000001572","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001572","url":null,"abstract":"<p><strong>Objectives: </strong>This study examined how the nursing work environment, ethical leadership, and organizational communication influenced just culture among hospital nurses and identified factors associated with just culture.</p><p><strong>Methods: </strong>A descriptive cross-sectional design was used. Data were collected from 199 nurses working in 7 hospitals (3 general hospitals, 1 women's hospital, and 3 small hospitals) in a metropolitan region of South Korea. Using a structured online questionnaire, we measured the nursing work environment, ethical leadership, organizational communication, and just culture. Multiple regression analysis was performed to identify factors significantly associated with just culture.</p><p><strong>Results: </strong>Ethical leadership emerged as the strongest predictor of just culture (β=0.460, P<0.001), followed by organizational communication (β=0.268, P<0.001). While the nursing work environment demonstrated a significant correlation with just culture (r=0.587, P<0.001), its effect was not significant in the final regression model. The overall model accounted for 51.8% of the variance in just culture. These findings suggest that day-to-day leadership behaviors and robust communication mechanisms exert a greater influence on nurses' perceptions of just culture than broader structural factors.</p><p><strong>Conclusions: </strong>Ethical leadership and open organizational communication appear pivotal for sustaining a culture of fairness and learning, while the work environment may operate through indirect pathways. Health care managers should prioritize ethical leadership development and strengthen communication systems to promote just culture and enhance patient safety outcomes.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}