FACTORS AFFECTING THE PRESENCE OF A BLAME CULTURE IN NURSES' PATIENT SAFETY INCIDENT REPORTS: A LITERATURE REVIEW

Abstract

Background: Patient safety is crucial in delivering high-quality healthcare services, and incident reporting is one of the primary mechanisms for improving patient safety systems. However, the blame culture within hospitals hinders healthcare workers, especially nurses, from reporting incidents. Blame culture stems from the fear of punishment and the potential negative impact on professional careers, obstructing transparency and learning from mistakes. This study aims to analyze the factors that influence blame culture in incident reporting related to patient safety by nurses. Methods: A total of 20 relevant studies published between 2015 and 2024 were systematically reviewed using PRISMA guidelines. These studies were analyzed for themes including organizational support, fear of punishment, leadership style, communication, and psychological safety. Results: It was found that the main contributors to blame culture include fear of punishment, high workload, lack of managerial support, unsupportive organizational culture, negative perceptions of the reporting system, and social and local cultural influences. On the other hand, mitigation strategies such as implementing a Just Culture, strengthening supportive leadership, patient safety training based on the Knowledge-Attitude-Practice (KAP) approach, open communication, and simplifying the reporting system have proven effective in reducing resistance to incident reporting. Conclusion: Blame culture is a systemic phenomenon that requires changes at various organizational levels. Institutional commitment is needed to build a patient safety culture based on learning rather than punishment. Further research is recommended to explore non-punitive policies' long-term effectiveness and examine the role of technology and psychological factors in patient safety incident reporting.