Research Topics and Trends on Patient Safety Error Reporting in Nursing

Article information

J Korean Acad Fundam Nurs. 2025;32(4):444-455

Publication date (electronic) : 2025 November 30

doi : https://doi.org/10.7739/jkafn.2025.32.4.444

Mi Ok Song¹⁾, Heeyoung Kim^2),

¹⁾Assistant Professor, Department of Nursing, Mokpo National University, Muan, Korea

²⁾Associate Professor, Department of Nursing, Dongshin University, Naju, Korea

Corresponding author: Kim, Heeyoung Department of Nursing, Dongshin University 34-26 Dongshindae-gil, Naju 58245, Korea Tel: +82-61-330-3585, Fax: +82-61-330-3580, E-mail: kimhy@dsu.ac.kr

*This study was supported by a grant from the National Research Foundation of Korea(NRF) and the Ministry of Science and ICT (Grant No. 2019R1G1A1099327).

Received 2025 June 13; Revised 2025 September 2; Accepted 2025 November 18.

Abstract

INTRODUCTION

Persistent clinical incidents, errors, preventable side ef-fects, and risks threaten patient safety, potentially increasing treatment burden, costs, and hospitalization period while elevating patient mortality rates [1]. Patient safety error reporting is a systematic process for healthcare providers to voluntarily report incidents that have caused or could cause harm to patients [2]. It serves as a key strategy for preventing the recurrence of such incidents and improving patient safety. To prevent the recurrence of patient safety errors, collecting and analyzing these incidents is crucial, integrating findings into clinical practice [3]. The World Health Organization (WHO) has developed a frame-work and models to promote error reporting [2]. However, reported errors significantly underrepresent actual incidents, with nurses finding error reporting challenging [4].

Research on patient safety error reporting encompasses various aspects, including promoting reporting and identifying barriers [5], evaluating strategies to foster a reporting culture [6], and systematically reviewing error reporting learning systems and interventions [7]. However, the patient safety error reporting status varies across coun-tries and organizations. Analyzing a limited number of studies to compare research trends is challenging because of the conceptual and cultural heterogeneity, making it difficult to avoid subjectivity in defining inclusion and exclusion criteria, potentially resulting in the analysis of only a few studies [8]. Therefore, establishing a comprehensive knowledge base in nursing science regarding patient safety error reporting is necessary to guide future nursing research directions.

Keyword network analysis and topic modeling are research methods that track changes in research topics over time and predict future issues using big data analysis [9]. Keyword network analysis helps interpret the dynamic knowledge structure of a research field through network analysis of published keywords. Topic modeling identifies latent themes in existing data or documents, analyzing topic connections and changes over time [10] and offering insights beyond conventional keyword network analysis.

Keyword network analysis and topic modeling are increasingly being utilized in the field of nursing, contributing to the direction of research in nursing practice and education. For example, a study analyzing nursing record narratives using topic modeling provided implications for improving patient care strategies and practice [11]. A com-parison of domestic and international studies on premature infants revealed differences in topic diversity and sug-gested potential for research expansion [12]. Furthermore, an analysis of virtual patient simulation and medication safety education identified key themes and future research directions [13,14]. These techniques are useful for systematically understanding the topic structure and changing patterns in nursing research and providing insights for future research.

This study aims to analyze nursing studies’ relevance and research trends on patient safety error reporting using network analysis and topic modeling, examine temporal changes in research, build a comprehensive knowledge base, and provide directions for future nursing research and practice.

METHODS

2. Data Search and Collection

A systematic literature search was conducted on Feb-ruary 1∼9, 2024, utilizing PubMed, CINAHL, and EMBASE databases to identify studies on patient safety error reporting within the nursing field published up to December 2023 in international journals. The search terms, based on a review of relevant studies [8,15], included "medical error," "risk management," "nurs*," and "safety." The search query combined the four main keywords, "medical error" [MeSH] and "risk management" [MeSH] and nurs* and safety.

The initial search identified 2071 studies (PubMed: 1040, CINAHL: 388, and EMBASE: 643). The inclusion criteria were studies addressing patient safety incident reporting, studies involving nurses or nursing students for error reporting, and studies published in peer-reviewed journals up to December 31, 2023. The studies that simply inves-tigated errors, identified error prevention strategies, examined the effectiveness of error prevention interventions, did not include nurses or nursing students as par-ticipants, or did not have an abstract were excluded. The exclusion process eliminated 347 duplicate studies (using EndNote 312, manual review 35), 145 studies without abstract, 1240 unrelated studies (studies that simply inves-tigated errors, addressed error prevention strategies, examined the status within error reporting systems, or eval-uated the effectiveness of patient safety error prevention programs, etc.), and 26 studies not involving nurses or nursing students. Two researchers independently reviewed the abstracts and applied the exclusion criteria, resulting in 313 studies for final analysis (Figure 1).

Figure 1.

Flowchart of the article inclusion process.

RESULTS

1. Keywords and Knowledge Structure of Patient Safety Error Reporting in Nursing Research

Analysis of the top 30 words based on simple appearance frequency, degree centrality, and betweenness centrality revealed key patterns in patient safety reporting research in nursing (Table 1). The top five keywords by simple appearance frequency were "system," "medication," "culture," "medication administration error," and "factor."

Table 1.

Top 30 Keywords by Frequency from Research on Patient Safety Error Reporting in Nursing

2. Trends in Patient Safety Error Reporting in Nursing Research Over Time

The analysis revealed a distinct shift in research focus across three phases. In the first phase (pre-2000), high-centrality keywords included "management," "quality," "process," "system," and "risk." However, during the second phase (2001∼2010), the term "system" maintained its prominence, but other previously high-ranking words decreased in degree centrality or disappeared entirely from the top 30. New high-ranking keywords emerged: "medication," "factor," "practice," "datum," "information," "culture," "attention," "perception," "implementation," and "barrier." Between 2011 and 2023, during the third phase, the keywords "medication," "system," "medication administration error," "training," and "perception" increased in centrality and maintained high rankings. Newly introduced top 30 centrality words included "training," "communication," "team," "experience," and "intervention" (Table 2).

Table 2.

Keywords According to Degree Centrality by Time

3. Topic Modeling of Patient Safety Error Reporting in Nursing Research

LDA analysis was performed to determine the optimal number of topics in research on patient safety error reporting. After the researchers discussed the LDA analysis results, K=6 was determined appropriate, minimizing re-dundancy while maintaining a meaningful distinction between topics. Therefore, the number of final topics was 6, and the topic modeling was performed with the combination of LDA parameters ⍺=0.1 and β=0.01. The main keywords and probabilities of the six topics are shown in Figure 2, the title and content of the original documents are checked, and the topic names are named as follows. The six identified topics, their proportions, and key com-ponents are as follows.

Figure 2.

Topic modeling of patient safety error reporting in nursing research.

Topic 1 accounted for 22.0% of the total topics and was composed of keywords related to "Error reporting culture," including culture, perception, communication, manager, and leadership. Meanwhile, Topic 2 accounted for 17.3% of the total topics and was composed of keywords related to "Medication error," such as medication, medication administration error, administration, impact, ICU, and drug. In addition, Topic 3 accounted for 16.9% of the total topics and was composed of keywords related to "Error reporting education," including practice, student, training, management, experience, and scenario. Topic 4 accounted for 13.4% of the total topics and was composed of keywords related to "Error reporting barrier," such as factor, barrier, attitude, knowledge, fear, and awareness. Moreover, Topic 5 made up 19.2% of the total topics and was composed of keywords related to "System failure analysis," including system, information, risk, use, analysis, and failure. Furthermore, Topic 6 accounted for 11.2% of the total topics and was composed of keywords related to "Quality improvement," such as process, datum, improvement, quality, intervention, and feedback. The temporal analysis of topic proportions (Figure 3) revealed that Topic 5 and 6 accounted for the largest proportion in the entire period; however, the proportion decreased over time. Meanwhile, the proportions of Topics 1, 2, 3 and 4 gradually increased over time.

Figure 3.

Trends in topic group proportions by period.

DISCUSSION

This study analyzed the core keywords of 313 patient safety error reporting studies in nursing to provide insights and scientific perspectives.

The analysis revealed that patient safety error reporting research in nursing clustered around the most frequent keywords: "system," "medication," "culture," "medication administration error," and "factor." These keywords with high degree centrality provided insights into their connections within the network. These keywords exhibited the highest centrality in the knowledge structure, reflecting the importance of a blame-free culture and a systems approach to errors in promoting patient safety incident reporting [21].

Literature trends in patient safety error reporting in nursing research were analyzed across three phases. Be-fore 2000, Studies in this phase primarily addressed risk assessment, critical incident report analysis, and medication error reduction strategies [22,23]. From 2001 to 2010, this period emphasized system approaches to patient safety, implementing unified reporting mechanisms, supporting open learning cultures, and focusing on system factors rather than individuals [24]. Research during this time promoted the use of system approaches, voluntary incident reporting systems, and data analysis for error prevention [25]. The 2010s saw the introduction of patient safety education curriculum guides for nurses and nursing students. The WHO released a multiprofessional patient safety curriculum guide [26], while the Quality and Safety Education for Nurses (QSEN) project identified safety as one of six core competencies for nurses [27]. The Canadian Association of Schools of Nursing and the Canadian Patient Safety Institute established standards for adverse event disclosure in undergraduate nursing programs [28]. Research during this period analyzed barriers and facilitators to error reporting [29], perceptions of error reporting [30], safety culture [31], multidisciplinary safety training [32], problem-based simulation education [33], and the effectiveness of error reporting education [34].

This study derived six topics for patient safety error reporting in nursing research through LDA topic modeling: "error reporting culture," "medication error," "error reporting education," "error reporting barrier," "system failure analysis," and "quality improvement." These results sug-gest future directions for patient safety error reporting studies.

The first topic, "error reporting culture," showed a relative increase in proportion over time. A reporting culture encourages healthcare professionals to report safety-re-lated errors or potential risks [35]. Promoting a reporting culture requires developing just culture that defines accept-able behaviors [36], encourages open communication and embraces diverse perspectives on errors [37]. Fostering an atmosphere of trust and respectful communication among all healthcare providers is essential for timely error recog-nition, management, and correction [38].

The second topic, "Medication error," highlighted that medication errors are the most frequently discussed type of error. Underreporting of medication errors is often due to fear of punishment, blame culture, legal liability, non- user-friendly systems, and inadequate feedback [39]. Education on medication administration should incorporate high-fidelity simulation or problem-based learning to help nurses and nursing students understand error-prone situations and apply theoretical knowledge effectively [40].

The third topic, "error reporting education," emphasized the importance of integrating error reporting education into nursing curricula based on a just culture [41]. While studies have integrated quality and safety education into clinical nursing practice [42], research studies specifically on error reporting education in nursing curricula are limited. Error reporting education should cover multidisciplinary topics such as human factors, systems thinking, teamwork, error management, and just culture, contextually linked to existing curricula [41,43]. And incorporate patient-centered theories, simulation-based training, problem-based learning, team-based learning, and virtual reality [44].

The fourth topic, "error reporting barrier," highlighted that healthcare providers are often reluctant to report safety incidents because of perceived negative reactions from team members and unit managers [45]. To overcome these barriers, implementing clear guidelines, simple reporting formats, protocols, feedback systems, and role models who promote error reporting is necessary. Establishing computer-based, confidential, and anonymous reporting systems, along with clear reporting pathways across all organizational levels, is important. In particular, digital health technologies utilizing AI or smartphone applications can enhance error reporting rates among not only nurses but also other healthcare professionals, while promoting patient safety engagement among patients and families.

The fifth topic, "system failure analysis," emphasized the importance of a system-based perspective in approaching errors [35]. Adverse events typically result from a series of errors and complex system factors [45]. Methods such as Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA) should be utilized for system analysis of errors [46,47]. These system failure analyses contribute to organizational learning and are likely to promote the development of an error-reporting culture.

The sixth topic, "quality improvement," focused on activities that encourage error reporting, including researching best practices, reforming current policies, creating safe environments for program feedback and modification, and integrating new technologies with current practices [48]. The error reporting system should focus on data en-try of errors using AI technology to collect free-text data and transform reports into a learning process through data analysis. In addition, a feedback system that encourages further reporting should be employed. Sharing improvements through hospital intranets and the annual patient safety fair [49], raising awareness through posters, bro-chures, patient safety rounds, and increasing customer engagement are necessary [50]. These efforts will improve the quality and increase the error reporting rate.

This study acknowledges several limitations that should be considered when interpreting its results. First, refining words from a large volume of data may have introduced researcher bias. To mitigate this, the researchers discussed creating thesaurus, exclusion and designated word dictionaries. They also sought validation from professors ex-perienced in TNA. This rigorous process aimed to derive results that best explain the study's knowledge structure, enhancing the findings’ reliability. Second, the use of text mining methods, primarily oriented toward quantitative analysis, limited the study's ability to conduct in-depth qualitative analysis of the papers included in the dataset. This limitation suggests that while the study provides valuable insights into broad trends and patterns in patient safety error reporting research, it may not capture the nuanced contextual details that a qualitative approach might reveal.

This study provides valuable insights into patient safety error reporting research in nursing and offers practical strategies for promoting error reporting. Nursing managers and leaders should focus on facilitating error reporting in policymaking, practice, and research that involves elevating the error reporting culture and removing barriers by supporting strategies and resources that encourage all healthcare personnel to participate in patient safety mis-reporting policymaking. In addition, implementing strategies such as providing appropriate feedback on errors, offering rewards and incentives for error reporting, and supporting secondary victims involved in errors can contribute to improved patient safety outcomes. Nursing educators should emphasize patient safety error reporting within their curricula on safety and quality of care, high-lighting the implications for organizational learning and improved patient safety. Education should incorporate system-based approaches, including knowledge of patient safety requirements for error reporting, systems thinking, the use of artificial intelligence technologies like chatbots for error reporting, and case studies on human error and root cause analysis. Evaluating the effectiveness of these educational interventions and incorporating findings into the continuous improvement of patient safety education programs is crucial.

CONCLUSION

The study findings highlight the need to promote error reporting through the establishment of a just culture, the development of a blame-free patient safety system, systematic reporting procedures, organizational learning through system failure analysis, and quality improvement activities related to patient safety. In addition, to help learners understand the value of error reporting, it is essential to implement anonymous reporting systems, provide education on voluntary reporting, offer interdiscipli-nary training, and enhance educators’ competencies in patient safety. Through these insights, the study presents practical recommendations for nursing educators, hospital administrators, and policymakers to support patient safety error reporting. These findings offer direction for patient safety education and are expected to contribute to the prevention of errors through learning from mistakes, the reduction in patient safety incidents, decreased healthcare costs, and the establishment of a trustworthy healthcare system.

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