Investigating the Relationship Between Cultural Competence, Patient Safety Culture, and Safe Nursing Care Among Nursing Students: A Multicenter Cross-Sectional Correlational Study in Iran

Introduction Patient safety issues have become a priority in health policy and health systems governance. This priority has drawn attention to health professionals’ licensing and effectiveness of the nursing curriculum in preparing students with the appropriate patient safety competencies. Despite their crucial role, there is a notable gap in the literature regarding the comprehension and competency of nursing students in patient safety within Iran. Objective This multicenter cross-sectional correlational study aimed to investigate the relationship between cultural competence, patient safety culture, and safe nursing care (SNC) among nursing students in southern Iran. Methods A total of 238 nursing students enrolled in clinical internship courses between November 2024 and February 2025 at three medical universities in Fars Province, Iran, were recruited using a census sampling approach. Data were collected through four instruments: (a) a demographic questionnaire; (b) the Hospital Survey on Patient Safety Culture, which measures perceptions of safety culture; (c) the Inventory for Assessing the Process of Cultural Competence, which evaluates cultural competence across five domains; and (d) the SNC tool, which assesses nursing performance in clinical skills, teamwork, and patient safety. Results The students reported moderate to high levels of cultural competence (75.73 ± 17.2), moderate perceptions of patient safety culture (116.02 ± 21.25), and moderate to good performance in SNC (245.29 ± 59.16). Correlational analysis revealed statistically significant and positive associations among the three constructs, with patient safety culture strongly correlated with SNC ( r = 0.68, p < .001) and moderately correlated with cultural competence ( r = 0.50, p < .001). In the SNC model (Adjusted R 2 = 0.46), academic year remained the strongest predictor (B = 44.536, 95% CI 33.201, 55.870, p < .001), highlighting the critical role of academic progression in enhancing safe care performance. Conclusion These findings underscore the need to integrate structured cultural competence and patient safety education into nursing curricula while expanding clinical learning opportunities in diverse healthcare environments. Furthermore, experiential training in multicultural settings may foster a deeper understanding of cultural and safety principles, thereby improving the quality of care at both individual and organizational levels.