Blended Learning for Patient Safety Education in Nursing and Midwifery Students

Overview

Patient safety education is important for preparing nursing and midwifery students to recognize risks, prevent avoidable harm, and provide safe care. This study evaluated whether adding structured online learning activities to face-to-face patient safety education improved students' perceived patient safety competence and general self-efficacy. First-year nursing and midwifery students were assigned to either a blended learning group or a face-to-face education group. Both groups received the same patient safety content through four classroom sessions delivered over two weeks. The blended learning group also used online case scenarios, scientific articles, topic summaries, and other educational resources. Outcomes were assessed before the educational program, immediately after the program, and two weeks later. This completed educational intervention study was registered retrospectively following a journal editorial request.

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.