Why doesn’t nurses’ compliance with safety procedures look the same everywhere?
Imagine two hospitals with identical patient safety protocols, yet with vastly different levels of nurse compliance. What accounts for the difference? According to a recent systematic review in palliative nursing, one answer is culture.
A systematic review published in Gaceta Médica de Caracas (Vol. 134, Supplement 1, 2026) by Sri Rusmini, Esti Yunitasari, and Hanik Endang Nihayati of the Faculty of Nursing, Universitas Airlangga, addresses this key question: how does cultural framing influence risk governance, and ultimately shape nurses’ compliance in delivering palliative care?
A problem often overlooked
Until now, many hospital risk governance models have been designed as “universal,” as though all nurses and patients share the same value background. In reality, cultural competence has long been recognized as important to patient safety, yet few studies have specifically examined how cultural values actually shape nurses’ compliance with risk procedures, particularly within palliative care, a field rich in emotional, spiritual, and end-of-life decision-making dimensions.
How the research was conducted
The research team systematically reviewed the scientific literature following the PRISMA 2020 guidelines, identifying studies published between 2001 and 2024 across PubMed, Scopus, CINAHL, and Google Scholar. The screening process was assisted by Rayyan software, while the quality of each study was assessed using the Mixed Methods Appraisal Tool (MMAT) 2018. This process yielded 26 studies that met the criteria for narrative analysis.
Three patterns identified
The synthesis revealed three major themes:
- Cultural competence as a framework for ethical risk-related decision-making — cross-cultural understanding helps nurses weigh risks more equitably and in ways that fit patients’ contexts.
- Cultural narratives shape nurses’ perceptions of risk and safety — how nurses view “what is dangerous” and “what is safe” is significantly influenced by cultural values, whether their own or those held by the patient’s community.
- Compliance as a culturally mediated behavioral outcome — compliance is not solely a matter of written rules, but also the result of interaction between institutional policy and local norms.
Another notable finding: when institutional policy aligns with local cultural norms, nurse compliance tends to rise. Conversely, cultural dissonance can hinder communication and risk reporting, a factor that may endanger patient safety.
What does this mean for nursing practice?
The authors concluded that integrating cultural framing into risk governance can enhance nurses’ responsiveness, improve communication with patients and families, and support more meaningful shared decision-making. They recommend that future nursing care models combine transcultural nursing theory, behavioral compliance frameworks, and ecological systems approaches.
In practical terms, this means:
- Nurse training should be culturally adapted, rather than following a one-size-fits-all approach across all locations.
- Risk governance policies should be context-sensitive, accounting for local values in the areas where care is delivered.
- Compliance evaluation should be conducted on an ongoing basis to assess the real-world impact of these cultural adjustments.
Conclusion
This review affirms that patient safety in palliative care is not solely a matter of technical procedure, but also a matter of how culture, values, and meaning are mutually understood among nurses, patients, and their families. Future empirical research is expected to test these culturally responsive governance strategies across various palliative care settings, with the goal of optimizing both nurse compliance and patient safety.
Author: Prof Dr Esti Yunitasari MKes
Source: Rusmini S, Yunitasari E, Nihayati HE. Culturally Framed Risk Governance Enhances Nursing Compliance in Palliative Care: A Systematic Review. Gaceta Médica de Caracas. 2026;134(Suplemento 1):S179–S192. DOI: 10.47307/GMC.2026.134.S1.21
