Assessing Patient Safety Culture: Validation of the Veterans Health Administration Patient Safety Culture Survey among Romanian Nurses

Abstract

Patient safety culture is essential for improving healthcare quality and reducing medical errors. In Romania, systematic assessment of this culture remains limited, particularly among nurses, who play a key role in preventing incidents. This study aimed to culturally adapt and psychometrically validate the Romanian version of the Veterans Health Administration Patient Safety Culture Survey (VHA-PSCS). The process included forward and backward translation, synthesis, and expert review. Validation was conducted on a sample of 352 nurses from various healthcare settings. Construct validity was assessed through exploratory and confirmatory factor analyses, while reliability was examined using Cronbach’s alpha coefficients. Factor analysis supported a three-factor structure explaining 60.57% of the total variance: (1) Risk Identification and Error Management, (2) Teamwork Cohesion and Engagement, and (3) Manager Trust and Communication. Confirmatory analysis indicated good model fit (CFI = 0.923; TLI = 0.911; RMSEA = 0.074). The instrument demonstrated excellent reliability (overall α = 0.948). A 3-factor (19-item) Romanian version of the VHA-PSCS was successfully validated and can be used to measure patient safety culture among nurses, as well as in future research studies.