The impact of nurses' perceptions of systems thinking on patient safety competencies: a cross-sectional study.

Background: Systems thinking-conceptualized as an approach for understanding the dynamic interactions and interdependencies among components within complex systems such as healthcare-has been widely recognized in the literature as a critical framework for strengthening patient safety competencies (PSCs). Despite this recognition, empirical studies specifically examining the impact of systems thinking on nurses' PSCs remain limited. Accordingly, the present study aims to examine the relationship between systems thinking and PSCs among Iranian nurses.

Methods: This study employed a cross-sectional descriptive design with a simple random sample of 400 nurses working in teaching hospitals in Qazvin, Iran between August and November 2024. Data were collected using the valid scales including, Systems Thinking Scale and the Patient Safety Competency Self-Evaluation tool for assessing perceptions of nurses towards systems thinking and PSCs, respectively. Data were analyzed using the independent sample t-test, ANOVA‌, and multiple linear regression.

Results: The mean score for systems thinking and PSCs was 56.77 ± 12.24 out of 80 and 3.65 ± 0.54 out of 5, respectively. A positive correlation was found between systems thinking and PSCs scores (r = .583, p < .001). The findings of multiple linear regression analysis indicated that the level of systems thinking significantly predicted PSCs after control demographic and professional characteristics as potential confounders (R² = 0.355; B = 0.026, 95% CI = 0.022 to 0.029; p < .001).

Conclusion: Nurses in the study population demonstrated moderate levels of both systems thinking and PSCs. These findings underscore the critical role of systems thinking in enhancing nurses' PSCs. The results can serve as a foundational basis for the formulation of hospital policies aimed at bolstering nurses' PSCs, thereby contributing to improved patient safety within healthcare settings. Policies and interventions on promoting systems thinking among nursing staff must be created and implemented. However, further studies using robust designs, including longitudinal and intervention research designs, are needed to examine the effect of systems thinking to enhance PSCs in nurses working in hospitals.