PATIENT SAFETY MANAGEMENT IN NURSING: TRENDS, CHALLENGES AND OPPORTUNITIES IN THE DEPARTMENT OF CESAR

Abstract

Cesar, with Valledupar as its main referral center, faces growing pressure on hospital services due to the high healthcare demand of a population of nearly one million inhabitants, characterized by high rurality and gaps in access to specialized services (Ministerio de Salud y Protección Social, 2024). Under these conditions, patient safety becomes a strategic priority, as limitations in infrastructure, coverage, and availability of human resources increase the risk of preventable adverse events. In this regard, this article analyzes patient safety management in nursing in the department of Cesar, identifying trends, challenges, and opportunities in a context of high rurality, service concentration, and structural and human resource gaps. The study is grounded in Donabedian’s model (structure–process–outcome), patient safety culture, and clinical nursing leadership. These conceptual frameworks help explain how structural, organizational, and educational factors affect the quality and safety of care. An integrative review was conducted, drawing on academic literature, national and international regulatory documents, and institutional reports from Cesar. Inclusion criteria covered the period between 2019 and 2025, with sources in English and Spanish, and the findings were organized into three analytical dimensions: trends, challenges, and opportunities. The results show progress in the implementation of safety protocols and training programs, but persistent challenges include underreporting of adverse events, nurse workload, and limitations in training. At the same time, opportunities were identified in strengthening nursing leadership, incorporating local safety indicators, and integrating patient safety into undergraduate nursing education. The discussion contrasts these findings with international experiences, highlighting similarities in structural barriers and marked differences in reporting culture. The findings provide inputs to guide regional policies, strengthen nursing education, and consolidate safe practices in territories with inequitable conditions. This study contributes to knowledge by integrating scientific literature and contextual evidence from Cesar, showing how nursing leadership can bridge national and international policies with local realities of coverage, quality, and sustainability.