Iran Journal of Nursing

Introduction
Patient safety is an important aspect of the quality of care. Due to the multidimensional nature of patient safety culture, the development of standard interventions to improve patient safety culture in organizations is one of the research priorities in developing countries. Understanding and establishing a patient safety culture affects work performance and interaction with colleagues and managers. To reach such an understanding, structured methods and quantitative tools are needed. Given that most of the studies in this field in Iran are quantitative and considering the critical and unstable conditions of intensive care unit (ICU) patients, the present study aimed to explore the experiences of patient safety culture in Iranian ICU nurses. 

Methods
This is a qualitative study using a conventional content analysis method. The qualitative data were collected by semi-structured interviews, each took 40-70 minutes. Using a purposive sampling method and until reaching data saturation, 18 ICU nurses from the hospitals in Tehran, Iran with a mean age of 38±14.45 years were selected for interview. The interview was started by asking general and guiding questions followed by specific questions based on the answers, to open the discussion and obtain in-depth information. The transcripts of interviews were analyzed using Graneheim and Lundman’s content analysis method. The trustworthiness of the data was determined using Lincoln and Guba’ criteria.

Results
All participants agreed that patient safety, as the main priority of the hospital, is one of the important indicators of hospital accreditation, and the first and most important requirement is not to harm the patient. The results of interview analysis revealed that the concept of patient safety is multidimensional and can be examined in three levels of individual, interpersonal and organizational. 

Conclusion
The three categories of individual, interpersonal and organizational dimensions emerged from analyzing the ICU nurses’ experiences, indicating that establishing and integrating an effective and positive safety culture into all parts of the organization should be the priority of hospital management programs. Also, to promote awareness in the field of patient safety culture while holding regular training courses, hospital managers should encourage non-punitive responses to errors and teamwork to clarify the performance and expectations of the health system about improving patient safety.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.FNM.REC.1397.209). The participants' information was kept confidential and their informed consent was obtained.

Funding
This study was funded by the Nursing and Midwifery Care Research Center of Tehran University of Medical Sciences.

Authors' contributions
Editing & review: Parvaneh Asgari and Mehrzad Mashayekhi; project administration and preparing the original draft: Parvaneh Asgari and Samrand Fattah Ghazi; methodology: Parvaneh Asgari; data collection: all authors; data analysis: Parvaneh Asgari & Samrand Fattah Ghazi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses participated in this study.


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