Factors Influencing the Development of Patient Safety Culture in the Undergraduate Nursing Student Population—An Integrative Review

Aims: To identify factors that influence the development of patient safety culture among nursing students. Design: Integrative review. Methods: A comprehensive literature search for publications from 2004 to 2024 was conducted using PubMed, LIVIVO, CINAHL, SCOPUS, and ERIC. A summarising content analysis was performed on 47 articles. Results: Students value patient safety but need guidance, supervision, structured education, supportive environments, interdisciplinary curricula, simulation training, and error-reporting training. Teamwork fosters learning, but hierarchical cultures, poor mentorship, unclear roles, stress, negative experiences, and bullying hinder communication and students' willingness to speak up. Emotions, identity, socialisation, and resilience shape students' safety practices, confidence, and advocacy. Conclusion: Enhancing nursing education, clinical environments, and policies is vital to patient safety practices among student nurses. Integrating comprehensive patient safety education, reflective learning, and structured transition programmes can bridge gaps between theory and practice, fostering critical thinking and confidence. Cultivating non-punitive cultures and collaboration across institutions and professions ensures learning, mutual support, and safer care delivery, with future research needed to assess long-term patient safety culture development. Impact: No comprehensive review has yet examined all factors influencing the development of patient safety culture in undergraduate nursing students. This review addresses this gap. Understanding these factors can foster a sustainable safety culture, reduce student stress, and guide improvements in education and clinical practice. Inadequate safety integration into curricula, hierarchical dynamics, and mentorship gaps risk undermining patient safety. By synthesising evidence from multiple studies, it yields comprehensive insights for both educational and clinical settings. The findings have important implications for educators, policymakers, and healthcare organisations, guiding improvements in curricula, teaching methods, and clinical learning environments to foster a robust patient safety culture from the beginning of training. Reporting Method: This study followed EQUATOR and PRISMA reporting guidelines for systematic reviews. Patient or Public Contribution: No patient or public involvement.