DOI: 10.5281/zenodo.15997731
title: Supplementary material and patient safety education appendices
title: Elevating patient safety education in undergraduate nursing: An integrative review beyond trends

description: Appendix A: Search Strategy

This appendix details the systematic search protocol used to identify relevant literature, adhering to PRISMA 2020 guidelines. It specifies the SCOPUS database query executed on January 5, 2025, covering peer-reviewed articles from 2015–2024 in English. The Boolean search strategy is outlined, combining terms related to patient safety, nursing education, and undergraduate training to ensure comprehensive retrieval of 6,889 initial records. This rigorous methodology underpins the review’s credibility, ensuring replicability and transparency in study selection.

Appendix B: Key Characteristics of Included Studies

Appendix B provides a detailed summary of the 21 studies included in the integrative review, covering publication details, objectives, methodologies, sample characteristics, key findings, and implications for patient safety education. It serves as a foundational reference, synthesizing empirical evidence from diverse research designs (qualitative, quantitative, mixed methods) to highlight trends, gaps, and pedagogical innovations in undergraduate nursing education. This tabular compilation ensures clarity and traceability of the evidence base.

Appendix C: Bibliometric Network of Co-occurring Terms

This appendix presents a bibliometric network visualizing keyword co-occurrences in patient safety education research (2015–2024). Generated using VOSviewer’s clustering techniques, it maps thematic linkages, emphasizing terms like “patient safety,” “nursing education,” and “clinical competence.” The network underscores the centrality of simulation-based learning and competency development, revealing a shift toward evidence-based pedagogies. It provides a quantitative lens on the field’s conceptual structure, complementing the qualitative synthesis.

Appendix D: Longitudinal Trend Analysis of Research Themes

Appendix D, created using Bibliometrix on Posit Cloud, tracks the evolution of research themes in patient safety education from 2015–2024. It highlights the persistent marginalization of patient safety in curricula despite its recognized importance, with dominant terms like “nurse,” “nursing student,” and “medication errors” indicating a focus on clinical competency. The analysis exposes gaps in curricular integration and advocates for sustained pedagogical strategies like simulation and quality improvement to bridge theory-practice divides.

Appendix E: Conceptual Structure Mapping (Multiple Correspondence Analysis)

Using Multiple Correspondence Analysis (MCA), Appendix E offers a two-dimensional conceptual map of patient safety education research (2015–2024). Dense clustering around “nursing student,” “nursing education,” “clinical competence,” and “patient safety” underscores their centrality. The map highlights the field’s focus on undergraduate training and competency development, reinforcing the need for evidence-based curricular reform to prioritize safety as a core competency rather than a peripheral topic.

Appendix F: Sankey Diagram of Keyword Associations and Geographic Trends

Appendix F’s Sankey diagram maps relationships between keywords, leading authors, and countries in patient safety education research (2015–2024). It identifies patient safety education as a central node, with significant research output from the USA and Iran, and emerging contributions from India, Australia, and Ethiopia. Underrepresented themes like prevention and drug safety, linked to China and Nigeria, signal global research disparities. This appendix emphasizes the need for inclusive, context-adaptive curricula to address inequities in safety education.

Appendix G: Emerging Trends in Patient Safety Education

This appendix catalogs transformative trends in patient safety education, including interprofessional simulation, non-punitive error disclosure protocols, and competency tracking via tools like H-PEPSS. It highlights the shift from skill-based learning to cultural enculturation, emphasizing systems-aware pedagogies that integrate human factors and organizational culture. However, it notes implementation challenges, such as resource disparities and hierarchical clinical norms, which hinder scalability and impact in diverse settings.

Appendix H: Comprehensive Curriculum Strategies

Appendix H proposes a tiered curriculum framework to embed patient safety as a core competency in nursing education. It advocates vertical integration across courses, interprofessional collaboration, and accreditation-driven mandates. Micro-curricular innovations—dedicated education units, gamified drills, and low-cost tools like mobile-based error reporting—ensure adaptability for resource-constrained settings. The framework’s evidence-based strategies, including a 38% reduction in latent error rates through early safety enculturation, offer a scalable blueprint for global reform.

These appendices collectively provide a robust, multi-faceted foundation for the review’s findings, combining methodological rigor (A, B), quantitative bibliometric insights (C, D, E, F), and practical recommendations (G, H). They underscore the urgent need for systematic, equitable, and evidence-based transformation in patient safety education to prepare nursing graduates for modern healthcare’s complexities.