Nurses in Bangladesh Show Gaps in Patient Safety Knowledge and Reporting, Landmark Survey Finds

In the crowded wards of Bangladesh’s tertiary medical college hospitals, nurses are the last line of defense between patients and preventable harm. A sweeping new survey of nearly 5,000 nurses across the country suggests that line is thinner than it should be. The study, published in Frontiers in Health Services, found that nurses scored an average of just 5.44 out of 10 on a test of patient safety knowledge, and that fewer than one in ten knew the correct procedures for reporting safety incidents to hospital authorities. The findings, drawn from one of the largest assessments of nursing safety culture ever conducted in South Asia, offer an unusually detailed portrait of where the gaps lie—and what might close them.

The research team, led by Md Abdul Khalek of Hiroshima University in Japan, together with colleagues at Hiroshima University and Unnan City Hospital, surveyed nurses in eight medical college hospitals spanning all eight administrative divisions of Bangladesh. Between April and September 2025, they distributed self-administered questionnaires to 7,170 eligible nurses; 4,982 completed responses were analyzed, a valid response rate of 69.5 percent. Because the sample covered every division of the country and captured nurses at different career stages, ward types, and educational backgrounds, the results provide a nationally representative snapshot of how frontline nurses in the public tertiary sector understand and practice patient safety.

The knowledge results were sobering. On a scale from 0 to 10, the mean knowledge score was 5.44 with a standard deviation of 1.82, meaning the typical nurse hovered around the midpoint of what the instrument considers adequate understanding of patient safety principles. At the item level, the picture grew more concerning: only 49.3 percent of respondents correctly identified what constitutes an adverse event, and a mere 9.8 percent knew the appropriate methods for reporting such events. In a hospital system where nurses perform the majority of direct bedside care, that means roughly half the workforce may not reliably recognize when a patient has been harmed by treatment rather than by disease—and almost none know the formal channel through which such harm should be flagged.

Practice scores told a parallel story. On a practice scale ranging from 10 to 50, the mean was 28.92 with a standard deviation of 7.76. But the most striking numbers emerged at the level of individual behaviors. Nearly half of the nurses—48.6 percent—reported never using incident-reporting forms, the basic paperwork that allows hospitals to track errors, near-misses, and adverse events. Another 26.4 percent said they never used structured communication tools, standardized formats designed to prevent the miscommunication that researchers have long identified as a leading cause of medical error. If almost half the nursing workforce is not filing incident reports, hospital administrators are operating with a fundamentally incomplete map of where patients are being harmed.

To understand why some nurses scored better than others, the team ran both bivariate analyses and a more sophisticated mixed-effects model that accounted for the clustering of nurses within hospitals. In the adjusted model, professional experience emerged as the most consistent factor: it was significantly associated with both knowledge (p < 0.018) and practice (p < 0.001). In-service training—continuing education delivered on the job—was also significantly linked to knowledge (p < 0.001) and practice (p < 0.019). Gender (p < 0.049) and holding a diploma in nursing (p < 0.027) were associated with knowledge, while age (p < 0.001), professional experience (p < 0.001), and in-service training (p < 0.019) were associated with practice.

Not all of these associations pointed in the expected direction. While knowledge and practice both rose with professional experience, the authors report that gender and nursing education showed negative associations with knowledge, and that age and in-service training showed negative associations with practice. In other words, more years on the ward appeared to sharpen both what nurses knew and what they did, but some demographic and educational variables behaved counterintuitively once other factors were held constant. The researchers suggest these patterns reflect the specific context of Bangladeshi tertiary hospitals, where career structures, training quality, and ward assignments vary widely, and they caution against reading the negative associations as evidence that education or training is inherently harmful.

The authors argue that the solution is not simply more training, but better-targeted training. They call for context-specific in-service programs paired with post-training monitoring by Quality Improvement Teams, the multidisciplinary hospital committees charged with tracking whether new knowledge actually changes bedside behavior. Without that follow-through, they note, training sessions risk becoming box-ticking exercises that produce certificates rather than safer wards. The finding that in-service training was linked to knowledge but showed a negative association with practice underscores this point: knowing the right answer on a questionnaire does not automatically translate into filling out an incident report at 3 a.m. on an understaffed ward.

Beyond training, the study points to structural fixes. The authors recommend strengthening patient safety reporting systems with leadership engagement, logistical support, and oversight from government regulatory bodies. The near-universal ignorance of appropriate reporting methods—only 9.8 percent knew them—suggests the problem may lie less with individual nurses than with systems that have never made reporting channels visible, accessible, or safe to use. In many low- and middle-income countries, incident reporting carries implicit risks of blame, and without leadership signaling that reports are welcomed and acted upon, the forms stay in the drawer. The Bangladeshi findings are consistent with a broader international literature showing that reporting rates rise when hospitals adopt non-punitive cultures and provide feedback on what happens to reports.

The scale of the survey lends the findings unusual weight. Cross-sectional studies of patient safety culture in South Asia have often been limited to single institutions or a few hundred respondents, making it hard to distinguish local quirks from national patterns. By sampling nearly 5,000 nurses across eight hospitals in eight divisions, the Hiroshima University-led team has produced one of the most statistically robust baselines available for any South Asian health system. That baseline matters because Bangladesh’s public hospitals serve tens of millions of patients, and because the country’s nursing workforce is a critical lever for the World Health Organization’s patient safety goals, which call for measurable reductions in preventable harm worldwide.

The study also carries a message for health systems far beyond Bangladesh. The specific gaps—unfamiliarity with adverse event definitions, near-total ignorance of reporting procedures, and low use of structured communication tools—are the same weak points documented in hospitals from Nairobi to Kathmandu, and the remedies proposed here are correspondingly portable. Experience and continuous, monitored training appear to be the strongest levers a health system can pull. As the authors conclude, improving nurses’ knowledge and practice will require not just classrooms but functioning reporting systems, engaged leadership, and regulatory oversight—a combination that turns individual awareness into institutional safety. For the nurses of Bangladesh’s medical college hospitals, and for the patients in their care, that combination cannot come soon enough.

Subject of Research: Nurses' knowledge and practice regarding patient safety culture in Bangladeshi tertiary medical college hospitals

Article Title: Nurses’ knowledge and practice on patient safety in tertiary medical college hospitals in Bangladesh: a cross-sectional study

Article References: Khalek, M. A., Huq, K. A. T. M. E., Babaita, A. O., Kimura, C., & Moriyama, M. (2026). Nurses’ knowledge and practice on patient safety in tertiary medical college hospitals in Bangladesh: a cross-sectional study. Frontiers in Health Services, 6, Article 1907119. https://doi.org/10.3389/frhs.2026.1907119

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1907119

Keywords: patient safety, nurses, Bangladesh, patient safety culture, tertiary hospitals, incident reporting, in-service training, adverse events, cross-sectional study, quality improvement, nursing education, health systems