Perceived patient safety competencies among Slovak nursing students: a psychometric analysis

Patient safety is a global priority and a core component of nursing education. Competence in this area encompasses cognitive, behavioral, and sociocultural skills such as teamwork, communication, risk management, and recognition of adverse events. The Health Professional Education in Patient Safety Survey (H-PEPSS) is an internationally validated tool designed to measure students’ self-perceived competencies in both classroom and clinical settings. To date, no validation of the H-PEPSS has been reported in Eastern Europe. Therefore, this study aimed to examine factor validity, reliability, and cross-setting measurement equivalence of the Slovak version of the H-PEPSS (H-PEPSSSVK) and to examine nursing students’ perceived patient safety competencies across classroom and clinical learning environments. This cross-sectional validation study was conducted between February and December 2024 across all nine Slovak public universities offering nursing programs. A total of 1,017 students completed the H-PEPSSSVK. The data were analyzed via confirmatory factor analysis (CFA) to test competing models, multi-group CFA (MG-CFA) to assess measurement invariance across the classroom and clinical settings, and reliability analysis (McDonald’s omega). Related samples nonparametric test was used to compare the scores across the two settings. The modified six-factor correlated model showed the best fit (RMSEA = 0.058; CFI ≥ 0.952; SRMR = 0.030), supporting the instrument’s theoretical structure. Strong factor loadings (0.686–0.852) and high inter-factor correlations (r = .686–0.857) together with HTMT values 0.70 for all domains; total scale ω = 0.95). Paired comparisons revealed small and significantly higher classroom scores in three domains, highlighting a persistent theory–practice gap. The H-PEPSSSVK is a valid, reliable, and contextually appropriate tool for assessing Slovak nursing students’ perceived patient safety competencies. Its use can support curriculum evaluation, educational reform, and international benchmarking, thereby contributing to safer patient care in Slovakia and beyond. Not applicable.