Introduction
Hospitals are key elements of the healthcare system. Their main goal is to deliver high-quality patient care. Care quality is a complex, multi-faceted concept. Patient safety is one of its most important components. Ensuring the competency of nurses in patient safety is crucial for delivering high-quality patient care. Considering the importance of nurses’ perception of patient safety and its challenges in special care units, as well as the lack of research on how nursing students in Guilan Province perceive patient safety, the current study aims to assess nursing students’ perception of patient safety in special care units in Guilan Province.

Methods
In this analytical cross-sectional study, participants were 233 nursing students from the nursing faculties of universities in Guilan Province, who were selected using a census method. Their perception of patient safety in special care units (ICU, CCU, and dialysis) was surveyed using the health care professionals patient safety assessment curriculum survey (HPPSACS) questionnaire with two domains: patient safety perception (attitude towards skills, comfort with skills) and error reporting. Data were analyzed using descriptive statistics and the Mann-Whitney U test, Kruskal-Wallis test, Friedman’s test, and Spearman’s correlation test.

Results
The mean scores of the HPPSACS domains in terms of demographic/educational factors are presented in Table 1. Friedman’s test results revealed a significant difference between nursing students’ perception of patient safety and error reporting behaviors (P<0.001). The results of Mann-Whitney U and Kruskal-Wallis tests showed that students <24 years old (P=0.006) and those studying in the lower semester (P=0.001) had a greater interest in error reporting. Those without clinical work experience reported greater comfort with patient safety skills (P=0.004). The Spearman correlation test results indicated no correlation between patient safety perception and error reporting behaviors (P=0.753).



Conclusion
Based on the research, most students had a good perception of patient safety in special care units. However, more than half of them exhibited inadequate error reporting behaviors. Most students agreed that errors of healthcare professionals are unavoidable. Many students noted a significant gap between what they know as best care and what they provide, highlighting the need to foster a safety culture, improve error management education, and address systemic deficiencies. Also, most students stated that they had committed medical and care errors during clinical practice. The occurrence of such errors in special care units is more concerning than in other wards because patients hospitalized in special care units often require special care due to their multiple organ failure and multiple abnormalities. The reported failure to complete error reporting forms in this study may be due to fear of being reprimanded. Currently, most developed countries have realized that simply having advanced management systems and technology is not enough to achieve sustainable development, but rather promoting safe behaviors among employees and the organization’s attitude towards safety is the way to prevent accidents. Students with no clinical experience tended to perceive patient safety more positively, and younger students were more likely to report errors. One of the limitations of the study was the mental state of the participants while completing the questionnaire, which can affect their responses.
It seems that the nursing curriculum has effectively contributed to shaping nursing students’ perception of patient safety, but their error reporting practices remain suboptimal. Factors such as fear of being reprimanded may affect their error reporting behaviors. Conducting more research to identify these underlying causes and developing practical strategies to eliminate them can improve error reporting behaviors of nursing students in special care units, thereby enhancing patient safety.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (Code: IR.GUMS.REC.1397.476).

Funding
This research did not receive any financial support from public, commercial, or non-profit funding organizations.

Authors contributions
Conceptualization, methodology, validation, investigation, resources, and visualization: Sara Mohammaddoust and Rasul Tabari; drafting of the manuscript: Sara Mohammaddoust; editing & review: Teri Chenot, Ezzat Pariad, and Rasul Tabari; Statistical analysis: Sara Mohammaddoust, Ehsan Kazemnejad, and Rasul Tabari; project management and supervision: Rasul Tabari.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nursing students who participated in this research for their cooperation.




 

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