Latent profiles and network characteristics of perceived patient safety culture among emergency and critical care nurses: a multicenter cross-sectional study.

aimTo identify latent profiles of perceived patient safety culture and examine associations among patient safety culture, missed nursing care and nurses' physical and mental health within the identified profiles.

backgroundPatient safety culture is a key organizational condition for safe nursing care. Emergency and critical care nurses practice in settings characterized by high clinical complexity, rapid decision-making, and substantial safety demands. Examining variations in their perceptions and associated occupational and health-related factors may inform safety management.

designA multicenter cross-sectional study.

methodsFrom January to August 2025, 3,351 emergency and critical care nurses from 22 tertiary hospitals in Hubei Province, China, were included. The Hospital Survey on Patient Safety Culture Version 2.0, Missed Nursing Care Survey, and 12-Item Short Form Health Survey were administered. Latent profile analysis was conducted using the nine patient safety culture dimension scores. An Mplus three-step multinomial logistic regression procedure examined characteristics associated with profile membership while accounting for classification error. Profile-specific network analyses examined conditional associations among patient safety culture, missed nursing care, and physical and mental health among nurses assigned to each profile based on their highest posterior membership probability.

resultsThree ordered profiles of perceived patient safety culture were identified: low (n = 778, 23.2%), moderate (n = 1,192, 35.6%) and high (n = 1,381, 41.2%). The profiles differed primarily in their overall levels across the nine dimensions. Compared with the high profile, membership in the low or moderate profiles was associated with poorer sleep quality, less favourable ratings of the nursing practice environment, poorer perceived nursing care quality, higher missed nursing care scores and poorer physical and mental health. The exploratory profile-specific network analyses indicated variation in conditional association patterns among nurses assigned to the three profiles. Emotional role functioning showed the highest overall connectedness in the low-profile network, whereas physical role functioning showed the highest overall connectedness in the moderate- and high-profile networks. The highest positive cross-domain connectedness was observed for organisational support for patient safety in the low profile, staffing and work pace in the moderate profile and mental health in the high profile. Missed nursing care showed net negative cross-domain connectedness in all three networks.

conclusionsPerceptions of patient safety culture were represented by an ordered low-to-high gradient rather than qualitatively distinct configurations. The observed profile associations and profile-specific network patterns are cross-sectional and exploratory, with the network findings conditional on model-derived profile assignment. Staffing and work pace, organisational support for patient safety, missed nursing care, and nurses' physical and mental health may warrant further organisational assessment and longitudinal investigation.