Nurses’ knowledge and practice on patient safety in tertiary medical college hospitals in Bangladesh: a cross-sectional study

Abstract

Patient safety is critical to healthcare and depends on a safety culture to ensure high-quality care. A strong patient safety culture (PSC) reduces preventable patient harm, with nurses’ knowledge and practices central to delivering safe care in hospitals. Yet, evidence remains limited in tertiary medical college hospitals in Bangladesh. Therefore, this study aimed to assess nurses’ knowledge, practices, and associated factors regarding PSC in tertiary medical college hospitals in Bangladesh. A cross-sectional study was conducted from April to September 2025 in eight medical college hospitals across all eight administrative divisions in Bangladesh. Of 7,170 eligible nurses, 4,982 (valid response rate 69.5%) were analyzed using a self-administered questionnaire. Descriptive, inferential statistics and correlation were performed. Participants’ mean scores were 5.44 (SD 1.82) (range: 0–10) for patient safety knowledge and 28.92 (SD 7.76) (range: 10–50) for practice. At the item level, 49.3% correctly identified adverse events, and only 9.8% knew the appropriate reporting methods. In terms of practice, 48.6% reported never using incident-reporting forms, and 26.4% reported never using structured communication tools. In bivariate analysis, participants’ education, working ward, and having in-service training were significantly associated with knowledge and younger age, hospital experience, working ward, and in-service training were significantly associated with practice. After adjusting in a mixed-effects model, professional experience ( p  < 0.018, p  < 0.001) and in-service training ( p  < 0.001, p  < 0.019) were significantly associated with knowledge and practice, respectively. Gender ( p  < 0.049) and diploma in nursing education ( p  < 0.027) were associated with knowledge, while age ( p  < 0.001), professional experience ( p  < 0.001), and in-service training ( p  < 0.019) were associated with practice. Nurses’ knowledge of patient safety increased with professional experience and in-service training; however, gender and education had negative associations. Nurses’ practices also increased with professional experience, while age and in-service training showed negative associations. Targeted, context-specific in-service training with post-training monitoring by Quality Improvement Teams is essential to improve nurses’ knowledge and practice. Strengthening patient safety reporting systems with leadership engagement, logistical support, and oversight by the government regulatory bodies may improve patient-safety practice and quality of care.