Association between nursing students’ self-reported professionalism and patient safety competencies: A cross-sectional study
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Abstract
Background & Aim: Nurses play a key role in safeguarding patients, highlighting the need to develop both technical competence and professional identity in nursing students. Although professionalism and patient safety competencies are widely studied, their association remains underexplored, particularly in Central Europe. This study examined the association between Slovak nursing students’ self-reported professionalism and patient safety competencies.
Materials & Methods: A cross-sectional study was conducted among 1,017 nursing students from all nine Slovak public universities offering bachelor’s and master’s programs. Data were collected between February and December 2024 using a questionnaire comprising the Slovak versions of the H-PEPSS and the NPI. Descriptive statistics, the Wilcoxon Signed-Rank test, and Spearman’s correlations were applied.
Results: Significant positive associations were found between professionalism and all patient safety competence domains in both academic and clinical settings (all p≤ 0.001), with the strongest correlations observed for Culture of safety (academic ρ= 0.347; clinical ρ = 0.400). After adjustment using partial Spearman correlations, Working in teams with other health professionals (academic ρ_partial= 0.112; clinical ρ_partial= 0.132) and Culture of safety (academic ρ_partial=0.108; clinical ρ_partial= 0.143) remained independently associated with professionalism. In the academic setting, Communicating effectively (ρ_partial = 0.068) and Understanding human and environmental factors (ρ_partial= 0.085) also showed small independent associations. Professionalism levels were high (Md= 129.0, IQR= 116.0–142.0).
Conclusion: Professionalism and patient safety competencies are closely interconnected among Slovak nursing students. Students who report stronger professionalism also report higher safety competence. Integrating both more deliberately in nursing education may help support safer practice.
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13. Boloré S, Fassier T, Guirimand N. Effect of an interprofessional simulation program on patient safety competencies of healthcare professionals in Switzerland: a before and after study. Journal of Educational Evaluation for Health Professionals. 2023;20:25. doi:10.3352/jeehp.2023.20.25
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15. Zhang X, Wang F, Wang Q, Liu Y, Li J. The link between patient safety competence and adverse events among master of nursing students: a cross-sectional mixed-methods study. BMC Nursing. 2024;23:539. doi:10.1186/s12912-024-02213-3
16. Ichikawa N, Yamamoto-Mitani N, Takai Y, Tanaka M, Takemura Y. Understanding and measuring nurses’ professionalism: development and validation of the Nurses’ Professionalism Inventory. Journal of Nursing Management. 2020;28(7):1607–18. doi:10.1111/jonm.13116
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20. Geoghan Marold SM, Strouse SM, Butcher D. Professional identity in nursing: a narrative review of the ISPIN definition and domains usage. SAGE Open Journal of Nursing. 2025;11:23779608251335240. doi:10.1177/23779608251335240
21. Bartoníčková D, Kohanová D, Cakirpaloglu SD, Steven A, Žiaková K. Exploring nursing students' perspectives on patient safety culture in clinical settings: a mixed-method study. Journal of Clinical Nursing. 2025;34(7):2702–17. doi:10.1111/jocn.17812
22. van Dongen D, Guldenmund F, Grossmann I, Groeneweg J. Classification of influencing factors of speaking-up behaviour in hospitals: a systematic review. BMC Health Services Research. 2024;24(1):1657. doi:10.1186/s12913-024-12138-x
23. Alhassan A, Sencherey VL, Bobuafor C, Berchie GO, Abraham SA. Practices and challenges of supervision and delegation in nursing in Africa: a scoping review. BMC Nursing. 2025;24(1):1094. doi:10.1186/s12912-025-03683-9
24. Carrillo I, Skoumalová I, Bruus I, Klemm V, Guerra-Paiva S, Knežević B, Jankauskiene A, Jocic D, Tella S, Buttigieg SC, Srulovici E, Madarasová Gecková A, Põlluste K, Strametz R, Sousa P, Odalovic M, Mira JJ. Psychological safety competency training during the clinical internship from the perspective of health care trainee mentors in 11 pan-European countries: mixed methods observational study. JMIR Medical Education. 2024;10:e64125. doi:10.2196/64125
25. Cornett M, Palermo C, Ash S. Professional identity research in the health professions: a scoping review. Advances in Health Sciences Education: Theory and Practice. 2023;28(2):589–642. doi:10.1007/s10459-022-10171-1
26. Mbalinda SN, Najjuma JN, Mubuuke AG, Kamoga L, Musoke D. Understanding and barriers to formation of professional identity among current and recent graduates of nursing and midwifery in two universities in a low-resource setting: a qualitative study. Research Square. 2023;rs.3.rs-3423723. doi:10.21203/rs.3.rs-3423723/v1
27. Fagan A, Lea J, Parker V. Student nurses’ strategies when speaking up for patient safety: a qualitative study. Nursing & Health Sciences. 2021;23(2):447–55. doi:10.1111/nhs.12831
28. Al-Daken L, Lazarus ER, Al Sabei SD, Alharrasi M, Al Qadire M. Perception of nursing students about effective clinical teaching environments: a multi-country study. SAGE Open Journal of Nursing. 2024;10:23779608241233146. doi:10.1177/23779608241233146
29. Wei H, Haddad LM, Nwokocha TA, Powers M, Wei A, Carroll Q, Ballard N. Organizational culture and roles in promoting nurse specialty certifications: a qualitative study in the United States. International Journal of Nursing Sciences. 2023;10(2):189–98. doi:10.1016/j.ijnss.2023.03.003
30. Krishna LKR, Kwok HYF, Ravindran N, Tan XY, Soh J, Wan DWJ, Rajalingam V, Lua JK, Leong EYM, Low TY, Chan AW, Lim CJN, Ng YK, Thenpandiyan AA, Lim AYD, Tse LN, Pl S, Rajanala SP, Leong JR, Quah ELY, et al. A systematic scoping review of mentoring support on professional identity formation. BMC Medical Education. 2024;24(1):1380. doi:10.1186/s12909-024-06357-3
2. Kim J, Lee M, Hong E. Evaluating the outcomes of patient safety education programs in nursing education: a scoping review. BMC Nursing. 2025;24:273. doi:10.1186/s12912-025-02858-8
3. Cao H, Cao Z, Mao Y, Li L, Song Y, He X, Wu Y, Chen Y, Wang Q, Yang H. A qualitative study on nursing professionalism: safeguarding life through a conceptual model. BMC Medical Education. 2025;25(1):1127. doi:10.1186/s12909-025-07595-9
4. Ginsburg L, Castel E, Tregunno D, Norton PG. The H-PEPSS: an instrument to measure health professionals’ perceptions of patient safety competence at entry into practice. BMJ Quality & Safety. 2012;21(8):676–84. doi:10.1136/bmjqs-2011-000601
5. Farokhzadian J, Eskici GT, Molavi-Taleghani Y, Akin S, Nayeri ND. Nursing students’ patient safety competencies in the classroom and clinical settings: a cross-sectional study. BMC Nursing. 2024;23:47. doi:10.1186/s12912-024-01708-3
6. Gradišnik M, Fekonja Z, Vrbnjak D. Nursing students' handling of patient safety incidents during clinical practice: a retrospective qualitative study. Nurse Education Today. 2024;132:105993. doi:10.1016/j.nedt.2023.105993
7. Alquwez N, Cruz JP, Alshammari F, Felemban EM, Almazan JU, Tumala RB, Alabdulaziz HM, Alsolami F, Silang JPBT, Tork HMM. A multi-university assessment of patient safety competence during clinical training among baccalaureate nursing students: a cross-sectional study. Journal of Clinal Nursing. 2019;28(9–10):1771–81. doi:10.1111/jocn.14790
8. Vaismoradi M, Tella S, Logan PA, Khakurel J, Vizcaya-Moreno F. Nurses’ adherence to patient safety principles: a systematic review. International Journal of Environmental Research and Public Health.2020;17(6):2028. doi:10.3390/ijerph17062028
9. Alrasheeday AM, Alkubati SA, Alqalah TAH, Alrubaiee GG, Alshammar B, Almazan JU, Abdullah SO, Loutfy A. Nursing students’ perceptions of patient safety culture and barriers to reporting medication errors: a cross-sectional study. Nurse Education Today. 2025;146:106539. doi:10.1016/j.nedt.2024.106539
10. Lee SE, Lee JW. Effects of hierarchical unit culture and power distance orientation on nurses’ silence behavior: the roles of perceived futility and hospital management support for patient safety. Journal of Nursing Management. 2024;2024:6564570. doi:10.1155/jonm/6564570
11. Hoffmann M, Schwarz CM, Schwappach D, Banfi C, Palli C, Sendlhofer G. Speaking up about patient safety concerns: view of nursing students. BMC Health Services Research. 2022;22(1):1547. doi:10.1186/s12913-022-08935-x
12. Jiang J, Liu M, Li Y, Gao H, Tian L. Nursing professionalism: a scoping review of implementation level, evaluation instruments, influential factors, and intervention strategies. Journal of Nursing Management. 2024;2024:7272296. doi:10.1155/2024/7272296
13. Boloré S, Fassier T, Guirimand N. Effect of an interprofessional simulation program on patient safety competencies of healthcare professionals in Switzerland: a before and after study. Journal of Educational Evaluation for Health Professionals. 2023;20:25. doi:10.3352/jeehp.2023.20.25
14. Chen L, Huang F, Yuan X, Song J, Chen L. An assessment of the reliability and factorial validity of the Chinese version of the Health Professional Education in Patient Safety Survey (H-PEPSS). Frontiers Psychology. 2019;10:2183. doi:10.3389/fpsyg.2019.02183
15. Zhang X, Wang F, Wang Q, Liu Y, Li J. The link between patient safety competence and adverse events among master of nursing students: a cross-sectional mixed-methods study. BMC Nursing. 2024;23:539. doi:10.1186/s12912-024-02213-3
16. Ichikawa N, Yamamoto-Mitani N, Takai Y, Tanaka M, Takemura Y. Understanding and measuring nurses’ professionalism: development and validation of the Nurses’ Professionalism Inventory. Journal of Nursing Management. 2020;28(7):1607–18. doi:10.1111/jonm.13116
17. Kurucová R, Kohanová D, Žiaková K. Self-report of nurse professionalism and factors affecting it: a cross-sectional study. Journal of Nursing Administration. 2023;53(9):467–73. doi:10.1097/NNA.0000000000001317
18. Kohanová I, Sollárová E. Nursing students’ self-reported competencies in patient safety: preliminary results. Zdravotnícke Listy. 2025;13(1):50–7.
19. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemioly. 2008;61(4):344–9. doi:10.1016/j.jclinepi.2007.11.008
20. Geoghan Marold SM, Strouse SM, Butcher D. Professional identity in nursing: a narrative review of the ISPIN definition and domains usage. SAGE Open Journal of Nursing. 2025;11:23779608251335240. doi:10.1177/23779608251335240
21. Bartoníčková D, Kohanová D, Cakirpaloglu SD, Steven A, Žiaková K. Exploring nursing students' perspectives on patient safety culture in clinical settings: a mixed-method study. Journal of Clinical Nursing. 2025;34(7):2702–17. doi:10.1111/jocn.17812
22. van Dongen D, Guldenmund F, Grossmann I, Groeneweg J. Classification of influencing factors of speaking-up behaviour in hospitals: a systematic review. BMC Health Services Research. 2024;24(1):1657. doi:10.1186/s12913-024-12138-x
23. Alhassan A, Sencherey VL, Bobuafor C, Berchie GO, Abraham SA. Practices and challenges of supervision and delegation in nursing in Africa: a scoping review. BMC Nursing. 2025;24(1):1094. doi:10.1186/s12912-025-03683-9
24. Carrillo I, Skoumalová I, Bruus I, Klemm V, Guerra-Paiva S, Knežević B, Jankauskiene A, Jocic D, Tella S, Buttigieg SC, Srulovici E, Madarasová Gecková A, Põlluste K, Strametz R, Sousa P, Odalovic M, Mira JJ. Psychological safety competency training during the clinical internship from the perspective of health care trainee mentors in 11 pan-European countries: mixed methods observational study. JMIR Medical Education. 2024;10:e64125. doi:10.2196/64125
25. Cornett M, Palermo C, Ash S. Professional identity research in the health professions: a scoping review. Advances in Health Sciences Education: Theory and Practice. 2023;28(2):589–642. doi:10.1007/s10459-022-10171-1
26. Mbalinda SN, Najjuma JN, Mubuuke AG, Kamoga L, Musoke D. Understanding and barriers to formation of professional identity among current and recent graduates of nursing and midwifery in two universities in a low-resource setting: a qualitative study. Research Square. 2023;rs.3.rs-3423723. doi:10.21203/rs.3.rs-3423723/v1
27. Fagan A, Lea J, Parker V. Student nurses’ strategies when speaking up for patient safety: a qualitative study. Nursing & Health Sciences. 2021;23(2):447–55. doi:10.1111/nhs.12831
28. Al-Daken L, Lazarus ER, Al Sabei SD, Alharrasi M, Al Qadire M. Perception of nursing students about effective clinical teaching environments: a multi-country study. SAGE Open Journal of Nursing. 2024;10:23779608241233146. doi:10.1177/23779608241233146
29. Wei H, Haddad LM, Nwokocha TA, Powers M, Wei A, Carroll Q, Ballard N. Organizational culture and roles in promoting nurse specialty certifications: a qualitative study in the United States. International Journal of Nursing Sciences. 2023;10(2):189–98. doi:10.1016/j.ijnss.2023.03.003
30. Krishna LKR, Kwok HYF, Ravindran N, Tan XY, Soh J, Wan DWJ, Rajalingam V, Lua JK, Leong EYM, Low TY, Chan AW, Lim CJN, Ng YK, Thenpandiyan AA, Lim AYD, Tse LN, Pl S, Rajanala SP, Leong JR, Quah ELY, et al. A systematic scoping review of mentoring support on professional identity formation. BMC Medical Education. 2024;24(1):1380. doi:10.1186/s12909-024-06357-3
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| Section | Original Article(s) | |
| Keywords | ||
| nursing education professionalism patient safety nursing students nursing | ||
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How to Cite
1.
Kohanová D, Sollárová A, Zrubcová D, Kolarczyk E, Botíková A. Association between nursing students’ self-reported professionalism and patient safety competencies: A cross-sectional study. Nurs. pract. today. 2026;:X-X.
