Evidence map›Paper›PMID 41580669›Full record

ArticleBMC nursing2026

From blame to learning: implementing a just culture program for head nurses and its impact on silent behavior and error reporting among staff nurses.

Fawzia Mohamed Mohamed Badran, Marwa Abd El Rahman Gaber Khalifa, Howaida Moussa Elghannam, Eman Hassan Mohamed Ali

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Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Fawzia Mohamed Mohamed BadranNursing Administration Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt.ORCID https://orcid.org/0000-0002-3801-0496
Marwa Abd El Rahman Gaber KhalifaNursing Administration Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt.ORCID http://orcid.org/0000-0003-2561-3500
Howaida Moussa ElghannamNursing Administration, Faculty of Nursing - Modern University for Technology and Information (MTI), Cairo, Egypt.
Eman Hassan Mohamed AliNursing Administration Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt. dr.eman.ali@nursing.asu.edu.eg.ORCID http://orcid.org/0000-0002-3789-1148

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEstablishing a Just Culture in healthcare is essential to improving patient safety, encouraging open communication, and reducing fear-based silence among staff. Nurse leaders play a critical role in modeling and promoting Just Culture principles. However, the impact of targeted Just Culture programs for head nurses on staff behavior remains underexplored.

aimThis study aimed to assess the effect of implementing a Just Culture program for head nurses on silent behavior and error reporting among staff nurses at Ain Shams Specialized Hospital, Egypt.

methodsA quasi-experimental, one-group pretest–posttest design was conducted at Ain Shams Specialized Hospital. The study sample included 70 head nurses and 400 staff nurses. Data were collected using five tools: (1) a demographic and work-related data sheet; (2) Head Nurses’ Just Culture Knowledge Assessment; (3) Just Culture Assessment Tool (JCAT); (4) the Silent Behavior Scale for Nurses (SBSN); and (5) the Staff Nurses’ Error Reporting Questionnaire. Statistical analysis was conducted using SPSS version 20. Paired sample t-tests were used to compare pre- and post-program scores. The Chi-square test was applied to assess changes in categorical variables (e.g. knowledge levels). A p-value ≤ 0.05 was considered statistically significant. Cohen’s d was used to determine effect sizes.

resultsFollowing the educational intervention, head nurses demonstrated statistically significant improvements in their knowledge and perceptions of Just Culture across all measured domains (p < 0.001). The overall Just Culture knowledge score increased markedly from a mean of 61.0 ± 9.5 pre-program to 88.5 ± 6.2 post-program, with large effect sizes (Cohen’s d 1.3) indicating a substantial impact. Similarly, perception showed a significant improvement following the intervention, increasing from a pre-program mean of 72.7 ± 10.2 to a post-program mean of 111.2 ± 8.6 (t = 13.95, p < 0.001). Among staff nurses, there was a significant reduction in silence behaviors, as evidenced by decreased scores on the Silent Behavior Scale for Nurses (SBSN) (p < 0.001), alongside notable increases in frequency and accuracy of error reporting post-intervention (p < 0.001). Effect sizes for all staff nurse outcomes were large (Cohen’s d 1.5), reflecting meaningful improvements in communication and error reporting culture.

conclusionImplementing a Just Culture educational program for head nurses led to significant improvements in managerial understanding and support for safety culture. These changes positively influenced staff nurses’ communication behaviors and error reporting practices. Findings suggest that leadership-based Just Culture programs can be an effective strategy for enhancing patient safety outcomes in hospital settings. CLINICAL

trial registrationNot applicable.

Indexed as

Error reportingHead nursesJust culturePatient safetySilent behaviorStaff nurses

Identifiers

PMID41580669
PMCPMC12849460

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.