Perceived Barriers and Facilitators to Whistleblowing in Healthcare Amongst Nurses: A Qualitative Study at a Private Tertiary Care Hospital, Karachi, Pakistan

Background : Whistleblowing in healthcare is crucial for upholding ethical standards, ensuring safety, and maintaining quality for providers and recipients of care. Cultural and systematic barriers often hinder whistleblowing efforts. Understanding these barriers and benefiting from facilitators is crucial for improving whistleblowing mechanisms in healthcare settings. Purpose: This study explored the perceived barriers and facilitators to whistleblowing among nurses at a private tertiary care hospital in Karachi, Pakistan. Method: A qualitative approach was implemented, involving in-depth interviews with 13 nurses. The interviews were meticulously transcribed and analyzed using Creswell’s (2013) content analysis methodology. This process involved coding the data, organizing it into categories, and identifying central themes to gain insights into the dynamics of whistleblowing. Ethical Consideration: The Ethical Review Committee at Aga Khan University, Pakistan, approved the study. All participants provided written informed consent, and confidentiality was ensured by assigning pseudonyms and securely storing the data. The data will be discarded following the university's seven-year disposal policy. Findings: The researchers extracted three main themes with corresponding categories: (1) Whistleblowing from Nurses’ Perspectives: whistleblowing as an ethical responsibility and a mechanism for improving patient safety and healthcare systems, (2) Barriers to Whistleblowing: lack of institutional support, cultural and social pressures, fear of consequences, and (3) Empowering Whistleblowers: implementing supportive institutional policies, strong leadership, and robust training and education programs for staff. Conclusion: The findings emphasize the need for a supportive framework in healthcare for whistleblowers. While ethical responsibility drives nurses to report wrongdoing, fear and cultural norms often hold them back. The Theory of Planned Behavior highlights how attitudes, norms, and perceived control influence whistleblowing decisions. Clear policies, strong leadership, and education can foster a culture that encourages whistleblowing and enhances patient safety.