Shahroud University of Medical Sciences Shahroud Journal of Medical Sciences 2423-6594 12 2 2026 05 02 Exploring the Barriers and Facilitators to Ensuring the Safety of Hospitalized Patients in Psychiatric Wards from Nurses' Perspectives: A Qualitative Study 37 48 eng Leila Dehghankar Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Nazila Javadi-Pashaki Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Mahdie Bahrami Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran. Sahar Nickbin Poshtamsary Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Mohammad Amin Jandaghian-Bidgoli Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Fatemeh Samiei Siboni Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran. 2025 09 23 2025 11 23 Background: Patient safety in psychiatric wards involves unique challenges beyond typical healthcare concerns, requiring specialized protocols to address risks such as self-harm, aggression, and environmental hazards. Nurses, as frontline caregivers, play a critical role in ensuring safety while balancing patient autonomy and recovery. This study explores nurses’ perspectives on barriers and facilitators of patient safety in psychiatric settings. This study, conducted in Qazvin City, Iran, addresses a gap in context-specific qualitative research. Methods: A descriptive qualitative design was employed following the COREQ checklist. Semi-structured interviews were conducted in three psychiatric wards at 22 Bahman Teaching Hospital in Qazvin, Iran. Nineteen registered nurses with at least one year of psychiatric experience were recruited, ensuring diversity in experience, gender, and ward type. Data were collected using an interview guide covering safety perceptions, barriers, facilitators, and improvement strategies. Thematic analysis using both inductive and deductive approaches was applied to extract key themes from the data with support from NVivo 12. Rigour was enhanced through member checking, triangulation, and reflexive journaling. Results: Four themes were identified through iterative coding and categorization of interview data: (1) perceptions of patient safety, emphasizing physical, emotional, and cultural dimensions; (2) barriers, including staffing shortages, inadequate training, patient-related challenges such as aggression and substance use, and environmental constraints such as poor ward design; (3) facilitators, including effective communication, teamwork, supportive management, and comprehensive training; and (4) strategies, such as improving staffing levels, enhancing training programs, modifying ward environments, and implementing evidence-based protocols. Nurses highlighted emotional safety and cultural competence as essential factors in reducing incidents and building trust. Conclusion: Patient safety in psychiatric wards involves a complex interaction of systemic, environmental, and relational factors. Addressing barriers such as understaffing and training gaps while strengthening facilitators such as communication and teamwork can improve safety outcomes. Context-specific strategies, including tailored protocols and ward redesign, are necessary to create safe and therapeutic psychiatric care environments. Keywords: Patient safety, Psychiatric nursing, Mental health, Thematic analysis, Qualitative research.