Patient safety competencies, which encompass the knowledge, skills and attitudes essential for safe healthcare delivery, are both vital and measurable. The Health Professional Education in Patient Safety Survey (H-PEPSS) is a validated instrument, that enables consistent comparison and assessment of these competencies in different countries. Although culturally and linguistically different, Estonia and Norway have comparable healthcare and education systems and a shared focus on strengthening patient safety. Consequently, a need to validate a relevant instrument for assessing patient safety in both contexts was identified.

To translate, validate and pilot the H-PEPSS for measuring patient safety competencies among nurses in Estonia and Norway.

A cross-sectional, multicentre study design was employed. The study was conducted in Estonia and Norway, at one university hospital and one higher education institution in each country, during 2021. The study utilised a blinded back-translation technique, cross-cultural adaptation, psychometric validation through confirmatory factor analysis, and pilot testing. There were 438 respondents: 226 from Estonia, including 178 nurses and 48 nursing master's students, and 212 from Norway, including 164 nurses and 48 master's students.

The measurement model of the translated instruments demonstrated a good fit. Convergent validity was confirmed by the variance of indicators and their strong relationship with the construct across all domains. Internal consistency was maintained in all domains, except understanding human and environmental factors in the Norwegian H-PEPSS. Discriminant validity could not be established across all constructs. Both Estonian and Norwegian samples reported having the least confidence in the working in teams domain.

The 16-item H-PEPSS, in its Estonian and Norwegian versions, is a valid and reliable instrument for measuring self-perceived patient safety competencies among nurses in these countries. The study highlights the instrument's applicability across diverse cultural contexts and its potential for comparing patient safety competencies on an international scale.