Blended Learning for Patient Safety Education in Nursing and Midwifery Students

This parallel-group controlled educational trial with quasi-random allocation was conducted among first-year nursing and midwifery students at a public university in Türkiye during the spring semester of the 2025-2026 academic year. The study evaluated the effect of a blended learning intervention on perceived patient safety competence and general self-efficacy.

Eligible students had not previously received formal patient safety education, had access to an internet-enabled computer, tablet, or smartphone, voluntarily agreed to participate, and completed the baseline assessment. A total of 110 students completed the baseline assessment and were allocated to the intervention group (n=56) or control group (n=54).

Participants were stratified into low-, medium-, and high-achievement categories according to tertiles of their baseline grade point average. Within each stratum, allocation was based on pre-existing, system-generated student identification numbers. A lottery was used to determine whether students with odd- or even-numbered identification numbers would be assigned to the intervention group.

Both groups received the same two-week face-to-face patient safety education program. The program consisted of four 90-minute classroom sessions, with two sessions per week and a total face-to-face teaching time of six hours. Topics included patient identification, medication safety, communication errors, infection prevention, fall prevention, adverse event reporting, and safety culture.

In addition to the classroom sessions, participants in the intervention group were given asynchronous access to structured online learning activities, including two case scenarios, selected scientific articles, researcher-prepared topic summaries, and supplementary educational resources. These materials were incorporated into subsequent classroom discussions and reinforced through instructor feedback. Participants in the control group received the same patient safety content through face-to-face instruction but did not have access to the online platform during the study.

Perceived patient safety competence and general self-efficacy were assessed at baseline, immediately after the two-week intervention, and at a two-week follow-up. The primary outcome was the total mean score of the Patient Safety Competency Self-Evaluation Tool. Secondary outcomes included its knowledge, skills, and attitudes domain scores and the total General Self-Efficacy Scale score.

This study was registered retrospectively after completion of participant recruitment, the educational intervention, follow-up, and data analysis.

• Blended Patient Safety Education (Behavioral): A two-week educational intervention comprising four 90-minute face-to-face classroom sessions combined with asynchronous online learning activities. The online component included two patient safety case scenarios, selected scientific articles, researcher-prepared topic summaries, and supplementary educational resources. The program addressed patient identification, medication safety, communication errors, infection prevention, fall prevention, adverse event reporting, and safety culture.
• Face-to-Face Patient Safety Education (Behavioral): A two-week educational intervention comprising four 90-minute face-to-face classroom sessions. The program covered patient identification, medication safety, communication errors, infection prevention, fall prevention, adverse event reporting, and safety culture. Participants did not have access to the online learning platform during the study.

Primary outcomes

• Patient Safety Competency Self-Evaluation Tool Total Mean Score [Baseline, immediately after the two-week intervention, and two weeks after completion of the intervention]: Perceived patient safety competence was assessed using the Turkish version of the 41-item Patient Safety Competency Self-Evaluation Tool. Items are rated on a 5-point Likert scale, and items 38 and 39 are reverse scored. The total score is calculated as the mean of all item scores and ranges from 1 to 5, with higher scores indicating greater perceived patient safety competence.

Secondary outcomes

• Patient Safety Competency Knowledge Domain Mean Score [Baseline, immediately after the two-week intervention, and two weeks after completion of the intervention]: The knowledge domain score of the Patient Safety Competency Self-Evaluation Tool is calculated as the mean of the relevant item scores and ranges from 1 to 5, with higher scores indicating greater perceived knowledge of patient safety.
• Patient Safety Competency Skills Domain Mean Score [Baseline, immediately after the two-week intervention, and two weeks after completion of the intervention]: The skills domain score of the Patient Safety Competency Self-Evaluation Tool is calculated as the mean of the relevant item scores and ranges from 1 to 5, with higher scores indicating greater perceived patient safety skills.
• Patient Safety Competency Attitudes Domain Mean Score [Baseline, immediately after the two-week intervention, and two weeks after completion of the intervention]: The attitudes domain score of the Patient Safety Competency Self-Evaluation Tool is calculated as the mean of the relevant item scores and ranges from 1 to 5, with higher scores indicating more positive attitudes toward patient safety.
• General Self-Efficacy Scale Total Score [Baseline, immediately after the two-week intervention, and two weeks after completion of the intervention]: General self-efficacy was assessed using the Turkish version of the 17-item General Self-Efficacy Scale. Items are rated on a 5-point Likert scale, and negatively worded items are reverse scored. Total scores range from 17 to 85, with higher scores indicating greater general self-efficacy.

Sex: All, accepts healthy volunteers

Inclusion Criteria:

* Enrollment as a first-year nursing or midwifery student at the participating university during the 2025-2026 academic year
* No previous formal patient safety education
* Access to a computer, tablet, or smartphone with internet access
* Voluntary agreement to participate and provision of informed consent
* Completion of the baseline assessment

Exclusion Criteria:

* Previous formal patient safety education
* Lack of access to a computer, tablet, or smartphone with internet access
* Declining to participate or provide informed consent
* Failure to complete the baseline assessment
* Withdrawal before group allocation