Association between nurses' experiences of workplace incivility and the culture of safety of hospitals: A cross-sectional Study.

AIM AND OBJECTIVES: This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals. BACKGROUND: Workplace incivility, which is characterised by low-intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace. DESIGN: Cross-sectional study. METHOD: This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit- and hospital-level PS culture as the dependent variables. RESULTS: 'Organizational learning-continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean = 2.27, standard deviation = 0.88). Working in Hospital B (ß = 0.24, p < .001, 95%CI = 0.15, 0.33) and having a baccalaureate degree in nursing (ß = 0.13, p = .014, 95%CI = 0.03, 0.23) were associated with better perceptions of unit-level PS, whereas working in medical-surgical wards (ß = -0.16, p = .002, 95%CI = -0.26, -0.06) and in intensive care units (ß = -0.19, p = .002, 95%CI = -0.32, -0.07) and experiencing patient/visitor incivility (ß = -0.09, p = .004, 95%CI = -0.15, -0.03) were associated with poor unit-level PS culture perceptions. Experiences of general incivility (ß = -0.24, p < .001, 95%CI = -0.35, -0.13) and supervisor incivility (ß = -0.26, p = .011, 95%CI = -0.46, -0.06) were associated with poor hospital-level PS culture perceptions. CONCLUSIONS: Workplace incivility from patients/visitors had a negative association with unit-level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital-level PS culture perceptions. RELEVANCE TO CLINICAL PRACTICE: The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit- and hospital-level PS culture are above standards.

Influence of student nurses' perceived caring behavior of their instructors on their psychological well-being: a cross-sectional study.

AIM: This study aimed to understand the influence of clinical instructors' caring behavior on the psychological well-being of student nurses. DESIGN: This study survey used the quantitative cross-sectional research design. METHOD: The sample comprised 405 Saudi nursing students studying at Shaqra University. The study used two instruments: the "Nursing Students' Perceptions of Instructor Caring" and the "Student Well-being Process Questionnaire." Convenience sampling was used to collect data from November 2021 to February 2022. RESULT: The students' perceived Instructor caring was high. The psychological well-being of students was high. There were significant variations in the students' perceived Instructor's caring in terms of year level. A very weak positive correlation existed between the student nurses' rank in their families and their perceived Instructor's caring. Furthermore, gender, year level, family structure, and the Instructor's caring subscales "supportive learning climate," "appreciation of life's meaning," and "control versus flexibility" were significant predictors of the student's psychological well-being. CONCLUSION: The study's results support studies that nursing students' psychological well-being is influenced by their gender, family structure, year level, and perceived Instructor's caring behavior.

Predictors of nursing students' intention to receive COVID-19 vaccination: A multi-university study in Saudi Arabia.

AIMS: This study examined the predictors of student nurses' intention to vaccinate against COVID-19. We measured the nursing students' risk perceptions, anxiety, fears and beliefs on COVID-19 vaccine; attitudes towards it and vaccine literacy (VL). DESIGN: This study is a multi-university study utilizing the quantitative, cross-sectional and predictive approach. METHODS: Using convenience sampling (n = 1170), we surveyed 10 Saudi universities from November 26, 2020, to December 31, 2020. Forward stepwise multinomial logistic regression was performed in identifying the factors predicting student nurses' intention to vaccinate against COVID-19. RESULTS: The overall mean in the risk perception, anxiety and fear was 9.59 (SD = 2.82, possible range = 1-15), 3.95 (SD = 4.77, possible range = 0-20) and 18.17 (SD = 6.65, possible range = 7-35) respectively. They also reported a mean of 29.90 (SD = 6.56, possible range = 8-40) on COVID-19 belief. COVID-19 positive and negative attitudes mean score was 3.64 (SD = 0.92) and 2.72 (SD = 0.90) in a 1-4 range of scores respectively. The functional and interactive-critical COVID-19 VL of the students were at moderate levels. More than half of the respondents (55.9%) intended to be vaccinated against COVID-19, 17.6% did not intend to do so and 26.5% were unsure. High-risk perceptions, low levels of COVID-19 anxiety, positive beliefs and attitudes towards COVID-19 vaccine, and high levels of interactive-critical COVID-19 VL were significant predictors of student nurses' intentions to vaccinate against COVID-19. CONCLUSION: Policymakers could consider the factors identified in this study and why the students did not intend to receive the vaccine in planning a nationwide vaccination program. The colleges of nursing could also utilize the findings in developing educational programs that aim to improve VL and beliefs and attitudes towards COVID-19 vaccine.

Examining the influence of health on employment and work ability of Saudi haemodialysis patients: A mixed-methods study.

AIMS: To explore the employment, work productivity, activity impairment, and sustainability of work of Saudi patients with chronic kidney disease (CKD) on haemodialysis (HD). BACKGROUND: Failure to address CKD-related challenges may cause HD patients to lose their job, create a lack of compassion from co-workers and receive discrimination hindering progress in their profession. DESIGN: This is a cross-sectional explanatory sequential mixed-methods study. METHODS: A convenience sample of 130 CKD patients was surveyed in the quantitative phase using the 'Short-Form Health Survey' and 'Work Productivity and Activity Impairment Questionnaire.' For the qualitative phase, face-to-face, semi-structured interviews took place with 16 CKD patients. Data were collected in 2017. RESULTS: The respondents reported poor physical and mental health. Both employed and unemployed respondents reported moderate levels of work productivity. Better physical health was related to an increased likelihood of being employed. Physical health was negatively correlated with presenteeism, whereas mental health was negatively associated with activity impairment. Five key themes emerged from the qualitative data: work retention, sustaining employment, suitability of work, losing the work and unemployment. CONCLUSIONS: Physical condition, personal distinctiveness, cultural and traditional aspects, and employment policies and approaches affect the employment status of CKD patients on HD.

The Influence of Sleep Quality on Patient Safety Learning of Nursing Students.

ABSTRACT: We investigated the influence of nursing students' sleep quality on their patient safety (PS) competence (i.e., knowledge of the dimensions of PS). The investigation surveyed 242 nursing students in a Saudi university. The majority of the surveyed students were characterized as having poor sleep quality. Notably, more male students experienced poor sleep quality than female students. The students reported the highest confidence in "culture of safety" and "managing safety risk"; they exhibited the poorest confidence in "working in teams." Increased length of sleep latency decreased sleep efficiency, and increased daytime sleepiness-related dysfunction was associated with reduced PS competence.

Whole-Person Development of Undergraduate Nursing Students: A Multi-University Study.

AIM: This study examines how nursing students in Saudi Arabia view their holistic development during university study and the association between their perceptions and academic performance. BACKGROUND: Holistic nursing education fosters broad development and emphasizes students' cognitive, emotional, social, physical, and spiritual potentials. METHOD: This descriptive and correlational study utilizes the Whole Person Development Inventory to collect data from 998 student nurses enrolled in six governmental universities in Saudi Arabia. RESULTS: The professional dimension recorded the highest mean, followed by the intellectual, spiritual, physical, and psychological dimensions. The social dimension received the lowest overall mean. Intellectual, psychological, social, and spiritual development has an association with high academic performance. CONCLUSION: This study encourages policymakers and various stakeholders concerned with nursing education in the country and worldwide to be intentional and systematic in adapting the whole-person development approach in nursing education.

Work engagement of nurses and the influence of spiritual climate of hospitals: A cross-sectional study.

AIM: This investigation was endeavoured to study the influence of the hospital's spiritual climate on nurse's work engagement in Saudi Arabia. BACKGROUND: Creating a safe clinical environment for nurses to express their spirituality despite preferences or religiosity is essential to increase work productivity, satisfaction and commitment. METHOD: This quantitative and cross-sectional research surveyed a convenience sample of 302 nurses employing the 'Utrecht Work Engagement Scale' and 'Spiritual Climate Scale'. RESULTS: The overall average of the respondents in work engagement was 4.33 (SD = 1.10), with more nurses reporting high or very high work engagement (53.7%). The hospital, age and spiritual climate were recognized as significant predictors of 'vigour'. The hospital's spiritual climate was the only significant factor influencing nurses' 'dedication'. The hospital and spiritual climate significantly influenced the variable 'absorption'. CONCLUSION: Having a positive hospital spiritual climate was associated with better work engagement among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The findings underscore the significance of ensuring that hospitals have positive spiritual climate and a clinical area that respects, accepts and welcomes various spirituality of nurses. Therefore, nurse managers should ensure that the spirituality of nurses has a safe home in the hospital.

Nurses' spiritual well-being and the COVID-19 pandemic: A thematic approach.

AIMS: This study explores nurses' perceived spiritual well-being in the workplace during the COVID-19 pandemic. BACKGROUND: Nurses have been working heavy shifts under challenging workplace conditions during the COVID-19 pandemic, leading to anxiety and psychological stress. These various challenges at work place their spiritual well-being at risk. METHODS: An unstructured individual online interview was conducted to collect data from 18 nurses from April to August 2021. Data were analysed using the thematic approach. RESULTS: This study highlighted the four themes of spiritual well-being of nurses, namely, "Trust in God," "spiritual encouragement," "spiritual attributes in the workplace," and "spiritual growth." CONCLUSIONS: The study concludes that spirituality is critical in helping nurses overcome the myriad of adversities they face as they assume their important roles during the ongoing pandemic. IMPLICATION FOR NURSING MANAGEMENT: The study emphasizes that nurses' spiritual aspect during crises is equally important with the other aspects of a nurse's life. Moreover, policies and interventions in hospitals must be implemented to ensure excellent levels of spiritual well-being among nurses.

Structural empowerment and work ethics influence on the work engagement of millennial nurses.

AIM: This study investigated the influence of structural empowerment and work ethics on work engagement among millennial Saudi clinical nurses. BACKGROUND: No extensive research has been conducted on the structural empowerment, work ethics and work engagement of millennial nurses, especially in Arab countries such as Saudi Arabia. DESIGN: This study utilized descriptive correlation quantitative design. METHOD: A total of 250 millennial Saudi nurses participated in the online survey containing the Multidimensional Work Ethic Profile-Short Form, Conditions for Work Effectiveness Questionnaire-II and Utrecht Work Engagement Scale. RESULTS: Descriptive analyses revealed the highest mean for 'delay of gratification' for work ethics (M = 4.38, SD = 0.66), 'access to opportunity' for structural empowerment (M = 4.28, SD = 0.78) and 'dedication' dimension for work engagement (M = 5.02, SD = 1.10). Regression analysis revealed that marital status, employment status, type of hospital, structural empowerment and work ethics influenced the work engagement of millennial Saudi clinical nurses. CONCLUSIONS: Personal and organisational factors, work ethics and structural empowerment contribute to the work engagement of millennial Saudi clinical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study discusses the importance of formulating strategies such as recognition, rewards and incentives for good nursing practice to foster the work engagement of millennial nurses.

The Compassion Competence Scale Arabic version: A validation study among student nurses and interns in Saudi Arabia.

AIM: The aim of this study is to assess the validity and reliability of the Compassion Competence Scale Arabic version for Saudi nursing students and interns. BACKGROUND: Compassion is an essential element of quality health care in which training nursing students to deliver compassionate care is important. Assessment of compassion competence of Arabic-speaking nursing students requires a valid and reliable tool. DESIGN: This is a descriptive and cross-sectional study. METHODS: This investigation was conducted from April to May 2019 in two universities in Saudi Arabia involving nursing students and interns. Cultural adaptation was performed using a forward-backward translation method. Content validity and construct validity through exploratory factor analysis were established. Internal consistency, stability and reliability were also determined for the scale. RESULTS: The Arabic version has an excellent content validity. The exploratory factor analysis supported a three-factor solution that accounts for 50.62% of the scale's variance. The Cronbach's alpha of the scale was 0.806, whereas the Cronbach's alpha of the subscales ranged from 0.739 to 0.797. The intraclass correlation coefficient of the two-week test-retest scores was 0.84. The university, gender, year level and family type predicted the students' compassion competence. CONCLUSION: The Arabic version can be used to measure Arabic-speaking nursing students' compassion competence in clinical areas.

Behind male Saudi nursing students' mental health facade: a husserlian phenomenological approach.

BACKGROUND: Every person has a persona (or mask) which is the façade that every person shows to the world. Thus, males use façade to reveal or conceal their true feelings and emotions. Also, the male uses mental health façade to protect themselves from prejudice and judgment. Thus, the study aimed to explore the experiences of male Saudi nursing students of mental health. METHOD: Husserl's descriptive phenomenology was used as a guiding lens to explore. Eleven participants were involved in the study by using the referral sampling technique. An unstructured interview was performed to gather information from the participants. The seven steps of the descriptive Colaizzi process were followed to investigate and examine the obtained data. The credibility, dependability, confirmability, transferability, and reflexivity criteria were observed to ensure the rigor of the study. RESULTS: The findings have two major themes. The first theme is the unadulterated smile that describes optimism in the family and mutual guarantee. The second theme is the orchestrated smile, which describes avoiding diverting burdens, social responsibility, protection of self, and reputation. CONCLUSIONS: The findings document that the mental health façade of male Saudi nursing students is associated with the expectation of family optimism, mutual guarantee, the expectation of society, and self-protection.

Risk perceptions, fear, depression, anxiety, stress and coping among Saudi nursing students during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has seriously impacted various aspects of the society on a global scale. Schools and universities provide rich resources for adolescents and young adults to develop significant coping mechanisms. AIM: This study assessed the perceptions of risk, fear, mental health status, and coping strategies among Saudi student nurses amid the COVID-19 pandemic. METHODS: Using an online survey, the mental health of the students was assessed by the Depression, Anxiety and Stress Scale short form version, whereas the coping was assessed by the Brief-Coping Orientation of Problem Experienced scale. RESULTS: The students had modest risk perception and fear of contracting COVID-19. "Religion" was reported as the most frequently used coping strategy. Approximately 43.3%, 37.2%, and 30.9% of the respondents manifested some degree of depression, anxiety, and stress, respectively. Poor COVID-19 knowledge, perceived seriousness of COVID-19 in Saudi Arabia, perceived risk of COVID-19 infection, and the use of some coping strategies were predictors of fear. Knowing someone infected with COVID-19, fear, and several coping strategies predicted students' mental health. CONCLUSION: This study provides data that can be used to create educational and health policies that focus on the mental health of university students, specifically nursing students.

Influence of Spiritual Coping and Social Support on the Mental Health and Quality of Life of the Saudi Informal Caregivers of Patients with Stroke.

The research explored the influence of spiritual coping and social support on mental health and quality of life (QOL) of informal caregivers of stroke survivors in Saudi Arabia. The respondents were frequently using religious coping strategies than existential coping strategies. The respondents received higher support from significant others and lowest support from friends. The majority of the respondents had mild to moderate depression, while more than one-third had mild to severe anxiety. Psychological health received the highest QOL, while physical health received the poorest QOL. Spiritual coping and social support significantly influenced the informal caregivers' mental health and QOL.

Examining the Influence of Workplace Incivility on Nurses' Patient Safety Competence.

PURPOSE: This study assessed clinical nurses' workplace incivility experiences and determined the effects of workplace incivility experiences on nurses' patient safety competence. DESIGN: This quantitative study surveyed 261 clinical nurses in two acute healthcare facilities in Saudi Arabia from June to August 2019. METHODS: A self-administered survey, including the Nurse Incivility Scale and the Health Professional Education in Patient Safety Survey, was employed to assess the variables workplace incivility and patient safety competence. The association between incivility and patient safety competence was analysed using multivariate multiple regression. RESULTS: The highest mean score was recorded for patient or visitor incivility, whereas the lowest score was recorded for supervisor incivility. Regarding patient safety competence, the dimension "communicating effectively" received the highest mean score, whereas "working in teams with other health professionals" was rated lowest. General and nurse incivilities had multivariate effects on the six dimensions of patient safety competence. CONCLUSIONS: Nurses' experiences of uncivil acts from nurses and from general incivility negatively impact nurses' patient safety competence. CLINICAL RELEVANCE: This investigation could guide the establishment of policies centered on boosting the patient safety competence of nurses by addressing uncivil acts in healthcare settings.

Spiritual climate in hospitals influences nurses' professional quality of life.

AIMS: To assess the nurses' perceptions of spiritual climate of their hospital and to examine how it influences their professional quality of life (ProQoL). BACKGROUND: Despite the advantages of positive spiritual organisational climate on the personal and professional lives of nurses, no study has attempted to investigate the influence of spiritual climate on nurses' ProQoL. METHOD: We surveyed 302 nurses in three general hospitals in Saudi Arabia in this cross-sectional study using the 'Spiritual Climate Scale' and the 'ProQoL scale version 5'. RESULTS: Our findings indicated a modest spiritual climate and average scores in ProQoL. Marital status, religion and education were significant predictors of the nurses' perception of spiritual climate. The spiritual climate, hospital, marital status, nationality, religion, education, experience in the country and experience in the present hospital played multivariate effects on the nurses' ProQoL. CONCLUSIONS: Our study concludes that the spiritual climate in hospitals influences nurses' ProQoL. IMPLICATIONS FOR NURSING MANAGEMENT: This research provides direction for hospital policymakers and nurse leaders on the areas that could be improved to ensure excellent ProQoL among nurses. Making sure that the nurses' unique spirituality is encouraged, respected and accepted in clinical areas could contribute to improving compassion satisfaction and decreasing compassion fatigue among nurses.

Influence of Religiosity on the Saudi Nursing Students' Attitudes Toward Older People and Perceptions on Elderly Care.

This cross-sectional study examined the influence of Saudi nursing students' religiosity on their attitudes toward older people and on their perceptions of elderly care. A sample of 175 nursing students of a government university in Saudi Arabia was surveyed using the Kogan's Attitudes toward Older People Scale, the Perspectives on Caring for Older Adults Scale, and the Muslim Religious Index. The students reported they are religious, they have modest attitudes toward older people, and they have neutral perception about elderly care. Religiosity showed a positive influence on the students' attitudes toward older people and on their perceptions about elderly care.

Influence of workplace incivility on the quality of nursing care.

AIMS AND OBJECTIVES: To examine the influence of workplace incivility on the quality of nursing care. BACKGROUND: Recent evidence describes workplace incivility as a serious concern in the healthcare setting worldwide. Exposure to workplace incivility can alter a nurse's behaviour, thought process and perspective towards the nursing profession. However, there is insufficient evidence to determine whether workplace incivility might be associated with the quality of nursing care in Saudi Arabia. DESIGN: A quantitative and cross-sectional study. METHOD: A survey was carried out amongst 378 nurses in two government hospitals in Saudi Arabia from February 2018-May 2018 using the Nurse Incivility and quality of nursing care scales. Multivariate multiple regression was performed to investigate the influence of the uncivil experiences of nurses from different sources on the different aspects of quality of nursing care. The study adhered to STROBE guideline (see Appendix S1). RESULTS: The overall mean of the quality of nursing care scale was 3.14 (SD = 0.66) from a scale of 1-5, with patient satisfaction receiving the highest mean dimension (mean = 3.27, SD = 0.72) and health promotion the lowest mean dimension (mean = 3.08, SD = 0.74). Experience in the present hospital and the hospital were associated with the overall quality of nursing care. General and nurse incivility exerted a multivariate effect on overall quality of nursing care and its different dimensions. CONCLUSION: General incivility and nurse incivility were found to negatively impact quality of nursing care and its different dimensions. RELEVANCE TO CLINICAL PRACTICE: Stronger policies geared towards eliminating workplace incivility should be implemented as uncivil acts can lead to poor quality of nursing care. Nurse administrators and nurses should be pro-active in recognising, preventing, approaching, reporting and intervening with uncivil acts in the hospital to protect these workers from these types of behaviours and avoid their negative impacts on patient care.

Workplace incivility and its influence on professional quality of life among nurses from multicultural background: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the workplace incivility of nurses working in two Saudi hospitals and analyse its influence on the nurses' professional quality of life (ProQOL). BACKGROUND: The prevalence and economic impact of workplace incivility cannot be overstated and disregarded. To the current authors' knowledge, no extensive study on this topic has been conducted in Saudi Arabia. The influence of workplace incivility to ProQOL of nurses from different cultural backgrounds has never been thoroughly investigated. DESIGN: Descriptive, cross-sectional design. METHODS: A sample of 378 nurses working in two government hospitals in Saudi Arabia were surveyed using the Nursing Incivility Scale and the ProQOL Scale version 5 from February to May 2018. A multivariate multiple regression analysis was conducted to analyse the multivariate effect of workplace incivility on the nurses' ProQOL. The study adhered to the STROBE guideline (See Supporting Information File 1). RESULTS: The nurses perceived a moderate level of workplace incivility from the different sources of uncivil acts measured in this study. Among the five sources of incivility explored in this study, the nurses reported the majority of workplace incivility experienced from patients/visitors (M = 2.44, SD = 0.80), while the lowest was from supervisors (M = 1.90, SD = 0.66). The mean scores of the respondents in the compassion satisfaction, burnout and secondary traumatic stress subscales were 36.50 (SD = 6.30), 26.43 (SD = 4.81) and 26.47 (SD = 6.06), respectively. General incivility, supervisor incivility, physician incivility and patient/visitor incivility showed a significant multivariate effect on the three ProQOL subscales. CONCLUSIONS: Nurses' experience of workplace civility and its sources were associated with ProQOL. RELEVANCE TO CLINICAL PRACTICE: The findings of this study can be used as guide in establishing human resource policies towards achieving nurses' needs, reducing workplace incivility and improving ProQOL.

A multi-university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross-sectional study.

AIMS AND OBJECTIVES: To assess the perceived patient safety competence during clinical training of Saudi nursing students. BACKGROUND: Ensuring safety in healthcare settings requires improvements in the educational and clinical practice of professionals. Experts stressed that shared patient safety culture must be of primary importance; they also emphasised the resolute need for theoretically driven research approaches for patient safety competence in healthcare organisations and educational institutions. DESIGN: Descriptive, cross-sectional design. METHODS: This study was conducted in six government universities in Saudi Arabia. A sample of 829 nursing students was surveyed using the health professional education in patient safety survey. Descriptive and inferential statistics were used to analyse the data. The study adhered to the STROBE guideline for cross-sectional studies (See Supporting Information Appendix S1). RESULTS: The percentage of agreement on the items of the health professional education in patient safety survey ranged from 61.5%-76.5%. The dimension "understanding human and environmental factors" received the highest perceived competence, whereas the dimension "working in teams" received the lowest competence. Significant differences in students' patient safety competence from different universities were reported. Male students perceived their competence in "working in teams" higher than the female students. Students in their internship year had significantly higher levels of competence in all the six dimensions of the health professional education in patient safety survey than students in the third- and fourth-year levels. CONCLUSIONS: Saudi nursing students have positive perceptions towards their patient safety competencies. Significant differences were found in the patient safety competence of nursing students between universities, gender and year of study. RELEVANCE TO CLINICAL PRACTICE: The results provide valuable insights and guidance for improving the patient safety competence of nursing students. The findings can be used to guide the creation of policies and interventions that may ensure the continuous development of patient safety competence of nursing students as they navigate the clinical area.

Nurses' Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia.

PURPOSE: To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. DESIGN: This study utilized a descriptive, cross-sectional design. METHODS: A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. RESULTS: From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. CONCLUSIONS: The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. CLINICAL RELEVANCE: The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.