Just Culture and Nurses’ Adverse Event Reporting Attitudes in Saudi Arabia: A Descriptive Predictive Correlational Study

Abstract

Aim: Just culture promotes fairness, trust, and shared accountability, which may encourage adverse event reporting. This study examined the role of Just Culture in adverse event reporting attitudes among nurses in four general hospitals in Riyadh, Saudi Arabia. Methodology: Using a quantitative descriptive–predictive correlational design, 147 nurses were selected through stratified random sampling. Data were collected using the adopted Just Culture Assessment Tool and the Reporting of Clinical Adverse Events Scale. Descriptive statistics, Spearman’s rho, rank-biserial correlation, and multiple regression analysis were employed using a 0.05 level of significance. Results: Findings revealed that nurses generally had favourable perceptions of Just Culture, with continuous improvement receiving the most favourable assessment, while balance emerged as the weakest dimension. Respondents also generally demonstrated positive attitudes towards adverse event reporting. Correlational findings showed a significant relationship between age and overall adverse event reporting attitudes (rₛ = .163, p = .049). Multiple regression analysis revealed that Just Culture significantly predicted adverse event reporting attitudes (F(6, 140) = 24.454, p < .001). The model explained 51.2% of the variance in adverse event reporting attitudes (R² = .512, adjusted R² = .491). Quality of the event reporting process (β = −.425, p < .001) and balance (β = −.348, p < .001) emerged as significant independent predictors. Conclusion: Just Culture plays a substantial role in how nurses perceive and respond to adverse event reporting, particularly through the quality of the reporting process and balanced accountability. The JUST CARE Programme was developed as a structured, hospital-based quality and patient safety intervention designed to transform Just Culture from an abstract institutional principle into a practical patient safety system.