Abstract
Background Ensuring patient safety is a major concern in healthcare, particularly in low-resource contexts. Nurses,
as frontline caregivers, play a pivotal role in identifying and reporting clinical incidents. However, underreporting
remains a persistent issue. Understanding nurses’ awareness of incident reporting systems and the barriers they face is
essential for improving safety outcomes.
Objective This study aimed to assess nurses’ awareness of incident reporting practices, explore their self-perceived
reporting behaviors, and identify barriers to effective reporting within Somali hospitals.
Methods A descriptive cross-sectional study was conducted among 300 nurses from public and private hospitals
across Somalia. Data were collected using a structured questionnaire adapted from a previously validated instrument.The questionnaire covered socio-demographic characteristics, awareness of incident reporting systems, self-perceivedreporting behaviors, and perceived barriers. Descriptive statistics, t-tests, and ANOVA were employed to analyze the data.Results Awareness of incident reporting systems was notably low; only 12% of nurses confirmed the presenceof such systems in their workplace, and just 26% had ever completed an incident report. Critical incidents such asmedication errors and breaches of confidentiality were frequently underreported, with over 40% of nurses admitting they had never reported such events. The gap between nurses’ belief in the importance of reporting and their actual practices was significant. Major barriers included fear of disciplinary action, lack of feedback, heavy workloads, and overly complex reporting procedures. Notably, nurses with longer professional experience and those working in
accredited hospitals demonstrated significantly higher awareness and reporting behaviors (p<0.001).

Conclusion The study identified substantial deficiencies in nurses’ awareness and incident reporting practices in
Somali healthcare facilities. Targeted interventions such as training programs, simplified and anonymous reporting
mechanisms, and a non-punitive culture are urgently needed to strengthen the patient safety framework and promote consistent incident reporting.

Keywords Incident reporting, Patient safety, Nurses, Barriers, Awareness, Somalia, Healthcare quality