Nursing safety culture in Saudi Arabia: a systematic review and meta-analysis
4 affiliations
- 1Medical and Surgical Nursing Department, College of Nursing, Northern Border University, Arar, Saudi Arabia
- 2School of Nursing, University of Wollongong, Wollongong, Australia
- 3Public Health Nursing Department, College of Nursing, Northern Border University, Arar, Saudi Arabia
- 4School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney, Australia
Abstract
Background: Safety culture is an important characteristic of healthcare settings as it influences the quality of care provided and patient outcomes. Nurses make up the largest proportion of the healthcare workforce and their attitudes towards safety are known to impact patient outcomes. To the best of our knowledge, this is the first systematic review and meta-analysis focused on nursing safety culture in Saudi Arabia. This study aimed to systematically synthesize the available evidence on nursing safety culture in healthcare settings in Saudi Arabia.
Methods: A systematic search of the literature was conducted in accordance with guidance from the Joanna Briggs Institute (JBI). Four databases were searched: Medline, CINAHL, Scopus, and Web of Science. Meta-analysis of the effect size was conducted using Jamovi version 2.3, and SPSS version 29 was used for subgroup analysis. The results are reported using the Preferred Reporting Items for Systematic Review and Meta- Analyses (PRISMA) guidelines.
Results: Thirty cross-sectional studies with a total of 8,910 nurses were included in this review. The meta-analysis included 24 studies with a total of 7,115 nurses. The pooled estimate of positive responses across the 12 subscales of the Hospital Survey on Patient Safety Culture score were 55.47% (95% CI, 48.11, 62.82). The highest percentage of positive responses was observed for ‘organizational learning and continuous improvement’ (71.81%, 95% CI, 63.40, 80.21) and ‘teamwork within units’ (71.40%, 95% CI, 62.88, 79.92). The pooled estimate of the mean percentage scores across the 5 subscales of the Safety Attitudes Questionnaire was 66.25% (95% CI, 56.82, 75.69). The highest mean score was observed for ‘job satisfaction’ (73.81%, 95% CI, 64.38, 83.25).
Conclusion: The findings highlight that a positive nursing safety culture is characterized by continuous learning, teamwork, and job satisfaction. These attributes build a strong foundation for collaboration and professional development. Nurses in Saudi Arabia had low scores related to communication, staffing, handoff processes, error management and stress recognition. These are all factors that can contribute to poor performance and threaten patient safety. To enhance nursing safety culture in Saudi Arabia, system wide improvements in communication and a reduction in workplace stressors are required. These changes will help to establish a more robust and efficient safety culture.
Supplementary information: The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05141-6.
Related
- Attitudes toward patient safety culture among respiratory therapy students: an online cross-sectional study in Saudi Arabia
- Microvascular and Macrovascular Complications and Their Associated Risk Factors Among Patients with Type 2 Diabetes in Saudi Arabia: A Systematic Review and Meta-Analysis
- Hepatitis B and Sharps Safety Before Nursing Clinical Placement: A Narrative Review and Proposed Framework for Resource-Constrained Hospitals
- Nursing Work Environments and Patient Safety in Older Adults: A Scoping Review of Their Intricate Relationship, Definitions and Theoretical Frameworks
- The perceived facilitators and barriers to the potential adoption of teledentistry among dental care providers in Saudi Arabia: A systematic review
BibTeX
@article{alanazi2026nursing,
title = {{Nursing safety culture in Saudi Arabia: a systematic review and meta-analysis}},
author = {Faisal Khalaf Alanazi and Luke Molloy and Ibrahim Naif Alenezi and Fathia Ahmed Mersal and Ohoud Naif Aldughmi and Jenny Sim},
journal = {BMC Nursing},
year = {2026},
month = aug,
doi = {10.1186/s12912-026-05141-6},
url = {https://doi.org/10.1186/s12912-026-05141-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Nursing safety culture in Saudi Arabia: a systematic review and meta-analysis
AU - Faisal Khalaf Alanazi
AU - Luke Molloy
AU - Ibrahim Naif Alenezi
AU - Fathia Ahmed Mersal
AU - Ohoud Naif Aldughmi
AU - Jenny Sim
PY - 2026
DA - 2026/08/06
JO - BMC Nursing
DO - 10.1186/s12912-026-05141-6
UR - https://doi.org/10.1186/s12912-026-05141-6
AB - Background: Safety culture is an important characteristic of healthcare settings as it influences the quality of care provided and patient outcomes. Nurses make up the largest proportion of the healthcare workforce and their attitudes towards safety are known to impact patient outcomes. To the best of our knowledge, this is the first systematic review and meta-analysis focused on nursing safety culture in Saudi Arabia. This study aimed to systematically synthesize the available evidence on nursing safety culture in healthcare settings in Saudi Arabia. Methods: A systematic search of the literature was conducted in accordance with guidance from the Joanna Briggs Institute (JBI). Four databases were searched: Medline, CINAHL, Scopus, and Web of Science. Meta-analysis of the effect size was conducted using Jamovi version 2.3, and SPSS version 29 was used for subgroup analysis. The results are reported using the Preferred Reporting Items for Systematic Review and Meta- Analyses (PRISMA) guidelines. Results: Thirty cross-sectional studies with a total of 8,910 nurses were included in this review. The meta-analysis included 24 studies with a total of 7,115 nurses. The pooled estimate of positive responses across the 12 subscales of the Hospital Survey on Patient Safety Culture score were 55.47% (95% CI, 48.11, 62.82). The highest percentage of positive responses was observed for ‘organizational learning and continuous improvement’ (71.81%, 95% CI, 63.40, 80.21) and ‘teamwork within units’ (71.40%, 95% CI, 62.88, 79.92). The pooled estimate of the mean percentage scores across the 5 subscales of the Safety Attitudes Questionnaire was 66.25% (95% CI, 56.82, 75.69). The highest mean score was observed for ‘job satisfaction’ (73.81%, 95% CI, 64.38, 83.25). Conclusion: The findings highlight that a positive nursing safety culture is characterized by continuous learning, teamwork, and job satisfaction. These attributes build a strong foundation for collaboration and professional development. Nurses in Saudi Arabia had low scores related to communication, staffing, handoff processes, error management and stress recognition. These are all factors that can contribute to poor performance and threaten patient safety. To enhance nursing safety culture in Saudi Arabia, system wide improvements in communication and a reduction in workplace stressors are required. These changes will help to establish a more robust and efficient safety culture. Supplementary information: The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05141-6.
SN - 1472-6955
ER -