Factors influencing patient safety competence among Chinese vocational nursing students: A mixed-methods study using COM-B model and theoretical domains framework.

Background: Although patient safety education is receiving increased attention, nursing students' patient safety competency remains moderate. As an important source of future caregivers for many primary health hospitals, the level of patient safety competence of higher vocational nursing students directly affects the delivery of nursing care, which in turn affects patient safety, the patient's disease healing process, and their outcomes. There is a lack of evidence to support the factors that influence patient safety competence among nursing students. Objective: The aim of this research was to explore the factors that impact patient safety competency among Chinese higher vocational nursing students. Design: An explanatory sequential mixed research design was used in this study. Methods: The quantitative part was a cross-sectional survey. Convenient sampling was used to conduct a questionnaire survey on 523 nursing students from a vocational college in Chongqing using the general information questionnaire, The metacognition ability scale, the general self-efficacy scale, the self-directed learning skill scale, patient safety nurse competency evaluation scale. Multiple linear regression and serial mediating effect test were used to analyze the impact factors. Qualitative research was then conducted to explain the initial quantitative research results. The qualitative research part used purposive sampling to conduct semi-structured interviews with 16 higher vocational nursing students, and the data was analyzed through content analysis. Quantitative and qualitative data are mapped to the Capability, Opportunity, Motivation, Behavior (COM-B) model. Results: The quantitative findings found that metacognition had a statistically significant indirect predictive effect on patient safety competence through general self-efficacy and self-directed learning, with an indirect effect value of 0.034 (95 % CI [0.017, -0.013]). Combining quantitative and qualitative results, The Capability, Opportunity, Motivation, Behavior (COM-B) model and theoretical domains framework captures a series of factors, including Competence (professional knowledge and skills); Opportunities (resources, public opinion); Motivation (metacognitive abilities, personality, roles, beliefs, goals). Conclusions: This study provides evidence for a serial mediating role of general self-efficacy and self-directed learning in the relationship between metacognition ability and patient safety competency, contributing to a psychological understanding of the underlying mechanisms of patient safety competency. Therefore, when developing interventions, consideration should be given to promoting positive behaviours in higher vocational nursing students concerning general self-efficacy and self-directed strategies to enhance metacognition, boost patient safety competency, and safeguard patient safety.