Table 2.

Descriptive data for all included studies.

Study	Year	Country	Design	Population	Aim/research question	Data collection	Most relevant results
Engle et al. [31]	2023	USA	Qualitative	Nursing home staff	To understand staff perceptions of resident safety	Interviews	Communication, leadership support, and responsiveness were identified as important aspects of a higher safety climate in nursing homes
He et al. [32]	2020	China	Cross-sectional	Nursing home staff	To explore factors associated with PSC and its relationship with obstacles to adverse event reporting	NHSOPSC, AEROS, demographic background	The multivariate regression model of patient safety culture showed a negative impact of privately owned facilities (Beta = −0.369, p < 0.001), reporting management (Beta = −0.330, p < 0.001), whether adverse events had occurred in departments (Beta = −0.139, p=0.001), punitive atmosphere (Beta = −0.101, p=0.044), and a positive association with increasing facility scale (Beta = 0.352, p < 0.001), whether it is an integrated care institution (Beta = 0.190, p=0.006), and frequency of concern about patient safety (Beta = 0.140, p=0.001); results showed a negative association between PSC and obstacles to adverse event reporting
Kim et al. [33]	2022	Republic of Korea	Review		To identify tools that measure patient safety and identify factors affecting patient safety		Most tools that measure patient safety were related to PSC and employees' attitudes; higher PSC scores were associated with lower medical defects; nursing homes scored lower than hospitals in PSC
Lee and Cho [34]	2022	Republic of Korea	Cross-sectional	Registered nurses and nursing aides	To identify the relationship between PSC and safety activities and to explore influencing factors	Korean patient safety culture scale for LTC facilities	A significant correlation between PSC and patient safety activities; factors influencing patient safety activities among RNs and NAs in LTC facilities were as follows: RNs (Î2 = 0.377, p < 0.001), organizational system of PSC (Î2 = 0.314, p < 0.010), and work shift type (fixed night shift, on-call, 24-h shift) (Î2 = −0.264, p = 0.004), which explained about 36.0% of total variance (F = 5.69, p < 0.001)
Liukka et al. [35]	2021	Finland	Cross-sectional	Manager, registered nurses, practical nurses	To examine whether PSC perceptions differ between managers and other professionals as well as between LTC and acute care	HSOPSC/NHSOPSC, demographic background, data from the incidence reporting system	Half of all reported incidents were accidents, commonly falls, presuming that falls are easier to report; managers estimate PSC more positively than other professionals; worst results were in composites that are related to managers' expectations and actions to promote and support PSC; therefore, staff felt that the organization is neither learning from the reported mistakes nor providing enough feedback
Quach et al. [36]	2021a	USA	Cross-sectional	CLC staff members	To examine the association of organizational readiness to change with safety culture	CESARS, ORCA, data about the structure and process of care	Organizational readiness to change was associated with safety climate; thus, it might be a requisite aspect for safety climate improvements; readiness to change in nursing homes (i.e., openness to change in frontline staff, opinion leaders, and senior managers and by communications between them) was an essential ingredient in a strong safety climate
Quach et al. [37]	2021b	USA	Cross-sectional	CLC staff members	To examine whether longer service is associated with more or with less positive safety climate perceptions	CESARS, staff, and facility characteristics	Staff with longer lengths of service perceived their safety climate less positively regarding their supervisor's commitment to safety, interactions with coworkers around safety, and the global ratings of their CLC than staff with shorter length of service; staff with longer service may have more knowledge of safety, making them especially critical of their supervisors, coworkers, and facility overall in terms of safety performance
Quach et al. [38]	2021c	USA	Cross-sectional	CLC staff members	To examine whether a more positive safety climate would be associated with lower rates of adverse events	Data of adverse events, CESARS, ORCA	Supervisor commitment to safety, environmental safety, and global rating of the CLC predicted four adverse events, which suggests that safety climate may be an organizational pathway to lower multiple adverse events; more positive ratings of supervisor commitment to safety were associated with lower rates of adverse events; associations between global ratings of the CLC and catheter use were in an unexpected direction (more positive ratings were associated with higher rates of catheter use)
Rand et al. [39]	2021	United Kingdom	Review		To identify measures that could be used as indicators of safety for quality monitoring and improvement		PSC was lower in nursing homes than in hospitals, with lower levels of learning from errors, less open communication, and a blaming or punitive culture among staff; work environment may influence resident safety outcomes more than the traits of individual care staff; workplace indicators may also be important sources of additional information to support the interpretation of harm-based indicators
Scott et al. [40]	2024	United Kingdom	Review		To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents and to note the types as well as the characteristics of safety incidents captured by safety incident reporting systems		Nurses were responsible for incident reporting more than any other profession or role, but it was unclear why nurses were most involved in incident reporting; there is no standard reporting system, however, many share common features; captured data are still heterogeneous; most frequent reported incident categories were patient behavior, clinical process/procedure, documentation, medication/intravenous fluids, and falls, which broadly reflects previous evidence; the most often identified factor in reducing risk was to improve safety culture; patient, staff, and organizational factors also contribute to safety incidents; regarding patients, cognition was the highest contributing factor to incidence occurrence
Seljemo et al. [41]	2020	Norway	Cross-sectional	Nursing home professionals	To assess the association between transformational leadership, job resource, job demand scores, PSC, and employees' overall perception of patient safety in nursing homes	NHSOPSC, GTL, SIMPH	Transformational leadership was identified as a strong predictor of PSC and the overall perception of patient safety; the only additional significant predictor was emotional workload, predicting perception of patient safety; job demands and job resources showed no significant improvement in explained variance in any of the final models
Serre et al. [42]	2022	Canada	Qualitative	Registered nurses, registered practical nurses, and personal support workers	To describe nurses' experiences with patient safety incident management involving residents living in LTC	Observations and interviews	Three main categories emerged in relation to participants' experiences with managing PSIs: (1) commitment to resident safety, (2) workplace culture, and (3) emotional reaction; furthermore, it was noted that PSIs were seen as opportunities for improving safety practices such as engaging in reflection postincident and learning with others; workplace culture captures the unit and team-level factors that influence nurses' PSI management experiences in LTC; participants also noted helpful working conditions when resources, such as equipment (e.g., for taking vital signs) and protocols for managing particular PSIs, were available
Teigné et al. [43]	2021	France	Cross-sectional	Nursing home professionals	To evaluate the level of SC and to identify factors that could predict SC scores	NHSOPSC-F (French version), descriptive variables for NHs	Compliance with procedures (Dimension 5) was lower among NHs with over 80 beds, those with a qualified, in-house risk manager, and those that used an external quality and RM provider; staffing (Dimension 6) was lower among NHs that had initiated a quality improvement approach; feedback and communication about incidents (Dimension 7) were lower for NH attached to a hospital than for those that were part of a group; there is also a clear link between perceptions of the difficulty of complying with procedures when the workload was high, and staffing levels were low
Teigné et al. [44]	2022	France	RCT	Nursing home professionals	To study the impact of a training package on safety culture and identify drivers for improvements	NHSOPSC-F, descriptive variables for NHs	Significant improvement in the dimension of “feedback and communication about incidents” of the NHSOPSC-F, drivers were found in Dimension 1 (percentage of members of the steering group who showed leadership, and in NHs with an active quality improvement approach), Dimension 3 (NH had an established policy of ongoing improvement in quality and RM), Dimension 4 (when the NH was hospital based, but not when it was independent, or when fewer staff wanted to use the knowledge acquired), and Dimension 6 (as a function of the percentage of members of the steering group who wanted to use the knowledge they had acquired, when there was an active quality improvement approach, and when the dependency score increased)
Temkin-Greener et al. [45]	2020	USA	Cross-sectional	Nursing homes (directors of nursing, facility leaders, and unit nursing leaders)	To examine the association between turnover of RNs and CNAs and perceived PSC in NHs	NHSOPSC, questions on staff turnover, NH characteristics	Low turnover of RNs and CNAs showed a strong, statistically significant, and positive association with PSC, both for the overall score and individually for most of the 12 domains; the PSC domains of teamwork, staffing, and training/skills appeared to be mainly related to CNA turnover but not to RN; PSC domains focusing on collaboration across disciplines and roles, such as compliance with procedures, handoffs, communication openness, and organizational learning, appeared to be equally associated with CNA and RN turnover, suggesting that the effect of turnover on PSC domains depends on the position that the person leaving had
Wang et al. [46]	2024	China	Cross-sectional	Nursing home staff	To explore the current status of AEs' reporting attitude, and the individual and organizational factors among nursing staff in nursing homes	Sociographic data, facility data, incident reporting attitude scale, adverse event reporting awareness scale, NHSOPSC	Strongest predictors for AE reporting attitude were organizational characteristics, particularly safety culture and AE reporting awareness; other predictors were individual characteristics such as education level and work experience
Yamamoto et al. [47]	2023	Japan	Qualitative	Nurses and caregivers	To identify the elements of safety behavior that allow nurses and caregivers to develop collaboratively a culture of safety in nursing homes	Interviews	Identified aspects for building a safety culture were open communication–promoting work environment, smooth information sharing, and role sharing based on expertise; mutual respect, acceptance of opinions, and good information sharing were described as beneficial; the development of an infrastructure of information sharing and the demonstration of collaborative skills were essential for building a safety culture

Abbreviations: AE, adverse events; AEROS, Adverse Event Reporting Obstacle Scale; CESARS, CLC Employee Survey of Attitudes about Resident Safety; CLC, community living center; CNA, certified nurse assistants; GTL, Global Transformational Leadership Scale; LTC, long-term care; NA, nurse aides; NH, nursing home; NHSOPSC, Nursing Home Survey of Patient Safety Culture; ORCA, organizational readiness to change assessment; PSC, patient safety culture; PSI, patient safety incidents; RM, risk management; RNs, registered nurses; SIMPH, short inventory to monitor psychosocial hazards.