This was a semi experimental study with a pretest, posttest, and follow-up design conducted in 2023 at Firouzgar Educational Hospital. The hospital has two separate buildings to prevent data contamination during the intervention. After providing informed consent from the Ethics Committee of the Iran University of Medical Sciences (IR.IUMS.1401.921), providing informed consent to the hospital director, and explaining the study objectives and coordination with the nursing office, sampling was performed using a random method.
Sixty-four nurses were selected for the study, 32 of whom were assigned to the intervention and control groups. Nurses with at least a bachelor's degree and a minimum of six months of work experience were chosen. The exclusion criterion included not participating in more than one training session and not participating in any of the assessment stages (before, after, and one month after the intervention).
After coordinating with the educational supervisor, workshops on patient safety were designed in the continuous training system. After providing informed consent for the intervention group, six 1.5-hour storytelling sessions on patient safety were designed, involving personal experiences in legal and patient safety issues in the form of storytelling without mentioning names or specific centers and engaging nurses in discussions and group work. Before each session, the researcher informed the participants about the storytelling topic. Storytelling session topics included medication errors, falls, unsafe discharge, personal consent, misdiagnosis, ineffective patient communication, lack of patient and caregiver education, improper patient assessment, and hemovigilance errors. In these sessions, experiences and incidents affecting patient safety were presented in the form of stories, and participants shared their work-related memories and experiences related to the topic in these workshops, effectively converting implicit knowledge into explicit knowledge. Patient safety culture in the intervention and control groups was evaluated before, after, and one month after the end of the storytelling sessions using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. No training was provided to the control group during the research period, and only at the end of the research were the training materials given to the intervention group in the form of handouts.
The tool used in this research is the Hospital Survey on Patient Safety Culture (HSOPSC), which consists of two sections: 1- The demographic information section of the questionnaire includes gender, education level, age, and work experience in the department, hospital work experience, hours worked per week, department name, and employment type. 2- The main section of the Hospital Survey on Patient Safety Culture (HSOPSC) version 1 includes 43 questions and twelve dimensions. Teamwork (4 questions), staffing (3 questions), compliance with procedures (3 questions), training and skills (4 questions), no punitive response to mistakes (4 questions), handoffs (5 questions), feedback and communication about incidents (4 question), communication openness (3 questions), supervisor expectations and actions promoting patient safety (3 questions), overall perception of patient safety (3 questions), management support for patient safety (3 questions), and organizational learning (3 questions) [10].
The responses are rated on a Likert scale (strongly disagree, disagree, neutral, agree, or strongly agree) from 1 to 5, and "do not know" responses are excluded from the total scores. A higher overall score indicates a better patient safety culture. This tool has been used in at least 20 European countries, including Sweden and Norway, as well as various studies in the United States, and its reliability has been confirmed (0.70–0.90) [10]. Additionally, this questionnaire has been used in numerous studies in Iran and has demonstrated good reliability for use in Iranian hospitals [11–17].
To assess reliability, the questionnaire was distributed among 20 randomly selected nurses in the research community, and the Cranach’s alpha for internal consistency was calculated as 0.71. Data analysis was conducted using SPSS version 16 software, employing repeated-measures ANOVA to compare the safety culture before, after, and one month after the intervention.