Supportive supervisors, unsupported systems: relational and structural just culture in nursing students’ needlestick injury reporting in Palestine — a qualitative study

Needlestick and sharps injuries (NSIs) pose serious occupational risks to nursing students, yet underreporting is the global norm. In the West Bank, military checkpoints, resource shortages, and conflict-related disruption may compound both injury risk and barriers to disclosure. To explore how nursing students in the West Bank experience, interpret, and act on NSIs, with particular attention to supervisory response and structural context in shaping reporting behaviour. A qualitative descriptive study using semi-structured interviews with 18 undergraduate nursing students who had personally sustained an NSI across ten hospitals in the Hebron, Bethlehem, Nablus, and Yatta areas. Interviews were conducted in Arabic, transcribed verbatim, and analysed using Braun and Clarke’s six-phase thematic analysis with independent double-coding. The Just Culture framework and Health Belief Model guided interpretation; reporting followed the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ). Five themes were developed. Theme 1 — Self-triage: students conducted covert informal risk assessments to justify non-disclosure. Theme 2 — Academic surveillance and the “careless student” label: fear of being judged incompetent and penalised academically was the most consistently cited barrier. Theme 3 — Financial and bureaucratic deterrents: anticipated out-of-pocket costs, confidentiality loss, and diffuse institutional responsibility reinforced concealment. Theme 4 — Structural and political strain: participants linked checkpoint-related fatigue to injury risk and delayed post-exposure care; one participant described sharps-safety equipment being moved during a mass-casualty influx, an illustrative account rather than evidence of how often such disruption occurs. Theme 5 (divergent case) — Relational Just Culture: a supportive first supervisory response was described by nine of the ten participants who disclosed their injury, although financial, bureaucratic, and structural barriers remained. Participants’ accounts suggest that Just Culture in this setting operates mainly as a relational achievement embodied in individual supervisors, not yet an institutional one. Durable safety is likely to require converting that interpersonal support into a systemic standard, alongside guaranteed post-exposure care, confidential reporting pathways, and conflict-resilient sharps infrastructure.