Patient safety as ethical practice: A qualitative study of the Protection of Life principle in nursing care

Background Patient safety is commonly conceptualized through ethical reductionism, risk management, and technical performance indicators. However, such approaches may insufficiently address the ethical, relational, spiritual, and culturally embedded dimensions of nursing care. Within Islamic ethical thought, the principle of Hifz al-Nafs (protection of life) offers a holistic moral framework for understanding patient protection beyond biomedical risk prevention. Aim This study aimed to explore Indonesian nurses’ ethical understandings and lived experiences of patient safety and caring and to examine how Hifz al-Nafs can serve as a culturally grounded ethical lens for interpreting these experiences. Research design A qualitative descriptive design was employed using semi-structured face-to-face interviews and thematic analysis following Braun and Clarke’s six-step framework. Participants and research context Twelve registered nurses from two tertiary hospitals in Indonesia participated in the study. Participants were purposively recruited to ensure variation in clinical experience and practice settings. Ethical considerations This study was approved by the relevant institutional ethics committees. A written informed consent was obtained from all participants, and participation was voluntary and de-identified. Results Three interrelated thematic clusters were identified: Institutional Gaps, Binary Framings, and Community Solidarity. Participants described patient safety as an ethically grounded practice integrating technical competence, relational ethical care, spiritual sensitivity, and communal responsibility. Hifz al-Nafs was used retrospectively as an interpretive ethical lens; participants did not explicitly use the term during the interviews. Conclusions The findings reconceptualize patient safety as an ethical and culturally situated nursing practice rather than solely a technical process. The study contributes a culturally grounded Caring-Safety synthesis that links procedural safety, relational care, and moral responsibility without claiming a universally transferable model.