Nurses' Perceptions Regarding Disclosure of Patient Safety Incidents in Korea: A Qualitative Study

Face Validity, Content Validity, and Psychometric Testing of the Hospital Survey on Patient Safety Culture Among Undergraduate Nursing Students

Background and Purpose: Nursing students have an essential role in patient safety. The purpose of this study was to evaluate the face validity, content validity, and psychometric properties of the Hospital Survey on Patient Safety Culture for Nursing Students (HSOPS-NS). Methods: The cross-sectional study was carried out between January and October 2021. The participants were undergraduate nursing students (N = 482) from 16 Czech nursing faculties. Results: Exploratory factor analysis revealed an 8-factor structure, which was verified by confirmatory factor analysis using the optimization process that results in adequate goodness-of-fit indices (root mean squared error approximation = .037; standardized root mean squared residuals = .056; comparative fit index = .935; Tucker-Lewis index = .926; incremental fit index = .936). The internal consistency of a new model was excellent (α = .914). Conclusion: The results indicate that the HSOPS-NS shows evidence of reliability and validity and is a valuable measure of safety culture as perceived by nursing students.

Effectiveness of a Patient Safety Incident Disclosure Education Program: A Quasi-Experimental Study

BACKGROUND

The accurate disclosure of patient safety incidents is necessary to minimize patient safety incidents and medical disputes. As prospective healthcare providers, nursing students need to possess the ability to disclose patient safety incidents.

PURPOSE

This study was designed to investigate the effect of a patient safety incident disclosure education program for undergraduate nursing students on participants' knowledge and perception of disclosure of these incidents, attitudes toward patient safety, and self-efficacy regarding disclosure of these incidents.

METHODS

A quasi-experimental study with a nonequivalent pretest-posttest design was conducted on fourth-year undergraduate nursing students recruited between September 6 and October 22, 2021, through convenience sampling from two universities in South Korea. The experimental group (n = 25) received the education program. The control group (n = 25) received educational materials on the disclosure of patient safety incidents only. Knowledge and perceptions of patient safety incident disclosure, attitudes toward patient safety, and self-efficacy regarding incident disclosure were measured. Data were analyzed using descriptive analysis, t test, χ2 test, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed-rank test, and ranked analysis of covariance.

RESULTS

Posttest results revealed knowledge (p < .001), perceptions (p = .031), and self-efficacy (p < .001) with regard to the disclosure of patient safety incidents were all significantly higher in the experimental group than in the control group. Posttest attitudes toward patient safety were not significantly different between the two groups (p = .908).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The patient safety incident disclosure education program effectively enhances the knowledge, perception, and self-efficacy of nursing students with regard to safety incidents. The findings may be used to improve training and educational programs in nursing colleges and hospitals to improve the knowledge, perception, and self-efficacy of nursing students with regard to disclosing patient safety incidents in clinical settings.

Barriers to implementing patient safety incident reporting and learning guidelines in specialised care units, KwaZulu-Natal: A qualitative study

BACKGROUND

Globally, increased occurrences of patient safety incidents have become a public concern. The implementation of Patient safety incidents reporting and learning guidelines is fundamental to reducing preventable patient harm. To improve the implementation of these guidelines in specialised care units in KwaZulu-Natal, the views of healthcare professionals were unearthed.

AIM

This study explores the healthcare professionals' views toward the implementation of Patient safety incident reporting and learning guidelines in specialised care units.

METHODS

A descriptive, explorative qualitative approach was used to collect qualitative data from healthcare professionals working in specialised care units. The study was conducted in specialised care units of three purposely selected public hospitals in two districts of KwaZulu-Natal. Group discussions and semi-structured interviews were conducted from August to October 2021. Content data analysis was performed using Tesch's method of analysis process.

RESULTS

The main themes that emerged during data analysis were; ineffective reporting system affecting the communication of Patient safety incident guidelines, inadequate institutional and management support for the healthcare professionals, insufficient education and training of healthcare professionals, and poor human resources affecting the implementation of Patient Safety Incident guidelines. The findings highlighted that there were more major barriers to the implementation of the Patient safety incident reporting and learning guidelines.

CONCLUSION

This study confirmed that the Patient safety incident reporting and learning guidelines are still not successfully implemented in the specialised care units and the barriers to implementation were highlighted. For rigorous implementation in South Africa, the study recommends revised Patient safety incident reporting and learning guidelines, designed in consultation with the frontline healthcare professionals. These must consist of standardised, simple- user-friendly reporting process as well as a better implementation strategy to guide the healthcare professionals. Continuous professional development programmes may play an important role in the facilitation of the implementation process.

The role of organizational culture and communication skills in predicting the quality of nursing care

AIMS

This study aims to identify the level of nursing care quality and examine its predictors considering nurses' demographic data, organizational culture, and communication skills.

BACKGROUND

Quality of care is a determinant of the sustainability of any healthcare organization. Therefore, it is imperative to understand how factors may contribute to the quality of nursing care. Limited research is available on the interaction between the concepts of quality of nursing care, communication skills, and organizational culture.

METHODS

A cross-sectional multi-site correlational design was used in this study. A convenience sample of 200 nurses from four Jordanian hospitals was recruited. Data was collected using self-reported questionnaires. Descriptive statistics, Pearson correlations, and multiple regression were performed to achieve the study's aims.

RESULTS

The majority of the nurses in this study were females with bachelor's degrees. Age ranged between 22 and 53 years whereas experience ranged from 1 to 30 years. Communication skills significantly predicted the quality of nursing care; however, organizational culture was not a significant predictor of the quality of nursing care. Nevertheless, Pearson r correlation results revealed a significant correlation between organizational culture and communication skills (r = 0.57, p < 0.05).

CONCLUSION

Nurses and organizational managers can increase the level of quality of nursing care by investing in programs that target improving nurses' communication skills. Providing a good environment in the hospital can increase communication skills between staff members, ultimately increasing the quality of nursing care. Further studies are recommended to elaborate and further uncover concerns related to the current research.

Nurses' perceptions of the influence of leadership behaviours and organisational culture on patient safety incident reporting practices

BACKGROUND

Patient safety is a priority for all healthcare organisations. Enhancing patient safety incident reporting practices requires effective leadership behaviours at all levels in healthcare organisations.

AIM

To explore nurses' perceptions of the influence of nurse managers' leadership behaviours and organisational culture on patient safety incident reporting practices.

METHOD

A descriptive, cross-sectional, correlational design was adopted with a convenience sample of 325 nurses from 15 Jordanian hospitals.

RESULTS

Respondents had positive perceptions of their nurse managers' leadership behaviours and organisational culture. There was a significant positive relationship between leadership behaviours and organisational culture (r=0.423, P<0.001) and between leadership behaviours and actual incident-reporting practices (r=0.131, P<0.001). Additionally, there was a significant positive relationship between organisational culture and incident-reporting practices (r=0.250, P<0.001).

CONCLUSION

Healthcare organisations must develop leaders who will foster a supportive and just culture that will enhance nurses' practice with regards to reporting patient safety incidents.

Health Workers' Perspective on Patient Safety Incident Disclosure in Indonesian Hospitals: A Mixed-Methods Study

Purpose

This study examined how health staff in Indonesian hospitals perceived open disclosure of patient safety incidents (PSIs).

Patients and Methods

This study employed a mixed method explanatory sequential approach. We surveyed 262 health workers and interviewed 12 health workers. Descriptive statistical (frequency distributions and summary measures) analysis was performed to assess the distributions of variables using SPSS. We used thematic analysis for the qualitative data analysis.

Results

We discovered a good level of open disclosure practice, open disclosure system, attitude toward open disclosure and process, open disclosure according to the level of harm resulting from PSIs in the quantitative phase. The qualitative phase revealed that most participants were confused about the difference between incident reporting and incident disclosure. Furthermore, the quantitative and qualitative analyses revealed that major errors or adverse events should be disclosed. The contradictory findings may be due to a lack of awareness of incident disclosure. The important factors in disclosing the incident are effective communication, type of incident, and patient and family characteristics.

Conclusion

Open disclosure is novel for Indonesian health professionals. A good open disclosure system in hospitals could address several issues such as lack of knowledge, lack of policy support, lack of training, and lack of policy. To limit the negative implications of disclosing situations, the government should develop supportive policies at the national level and organize many initiatives at the hospital level.

Exploring the relationship between nursing work environment and medical error reporting among Jordanian nurses: a cross-sectional study

Objectives

This study was conducted to explore the relationship between the nursing work environment and medical error reporting practices among Jordanian nurses.

Methods

This study was a cross-sectional survey of 334 participants who were conveniently selected from three types of hospitals (private, teaching and public) in Amman city, Jordan. The data were collected using a standardized questionnaire which was adopted from previous studies and consisted of three main sections including demographics, nursing work environment (The Practice Environment Scale-Nursing Work Index) and medical error reporting practices (incident reporting practice scale). SPSS version 26 was used for data analysis.

Key findings

The study findings detected a strong positive relationship between the nursing work environment and medical error reporting practices. ‘Nurse’s participation in hospital affairs’ showed the highest impact on medical error reporting practices among nurses. Based on the regression model, the nursing work environment explained 65.1% of variations in nurses’ medical error reporting practices. It was found that medical error reporting practices were statistically different across marital status and hospital type.

Conclusions

Based on data analysis findings, the nursing work environment was statistically strongly correlated to medical error reporting practices. To improve medical error reporting practices among nurses, decision-makers and hospital administrators should redesign their nursing work environment to create a more positive and favourable work environment.

Understanding Physicians' and Nurses' Adaption of National-Leading Patient Safety Culture Policy: A Qualitative Study in Tertiary and General Hospitals in Korea

BACKGROUND

In Korea, the safety culture is led by national policy. How the policy ensures a patient safety culture needs to be investigated. This study aimed to examine the way in which physicians and nurses regard, understand, or interpret the patient safety-related policy in the hospital setting.

METHODS

In this qualitative study, we conducted four focus group interviews (FGIs) with 25 physicians and nurses from tertiary and general hospitals in South Korea. FGIs data were analyzed using thematic analysis, which was conducted in an inductive and interpretative way.

RESULTS

Three themes were identified. The healthcare providers recognized its benefits in the forms of knowledge, information and training at least although the policy implemented by the law forcibly and temporarily. The second theme was about the interaction of the policy and the Korean context of healthcare, which makes a "turning point" in the safety culture. The final theme was about some strains and conflicts resulting from patient safety policy.

CONCLUSION

To provide a patient safety culture, it is necessary to develop a plan to improve the voluntary participation of healthcare professionals and their commitment to safety. Hospitals should provide more resources and support for healthcare professionals.

Perception Gaps of Disclosure of Patient Safety Incidents Between Nurses and the General Public in Korea

OBJECTIVES

This study aimed to explore nurses' perceptions regarding disclosure of patient safety incidents.

METHODS

An anonymous online survey was conducted, and results were compared with those of the general public using the same questionnaire in a previous study.

RESULTS

Among 689 nurses, 96.8% of nurses felt major errors should be disclosed to patients or their caregivers, but only 67.5% felt disclosure of medical errors should be mandatory. In addition, 58.5% of nurses were concerned that disclose will increase the incidence of medical lawsuits. More than two-thirds of nurses felt such discloses will reduce feelings of guilt associated with a patient safety incident. Only 51.1% of nurses, but 93.3% of the public, felt near misses should be disclosed to patients.

CONCLUSIONS

Nurses generally had a positive attitude toward disclosure of patient safety incidents, but they preferred it less than the general public. To reduce this gap, legal and nonlegal measures will need to be implemented. Furthermore, it is necessary to continue monitoring the gap by regularly assessing perceptions of disclosure of patient safety incidents among health care professionals and the general public.

Patients' and Families' Experiences Regarding Disclosure of Patient Safety Incidents

In South Korea, disclosure of patients' safety incidents is not common in health care settings. Thus, this study identified patients' and families' experiences regarding disclosure of patient safety incidents. Data were collected through in-depth individual interviews from May 25, 2020, to June 23, 2020, and analyzed using Colaizzi's phenomenological method. The participants consisted of 15 patients and their families who had experienced patient safety incidents in hospitals. It is essential to form a base of mutual understanding to enable disclosure and promote follow-up management systems that can ethically and responsibly handle patient safety incidents. Concrete protocols and policies need to be developed to protect patients and their families from physical/psychological injury and the stress experienced due to patient safety incidents. The patients and their families desired changes to improve protocols for proper disclosure, help health care professionals adopt an ethical and mature attitude, and develop professional health care policies regarding patients' safety incidents.

Nurses' experiences in voluntary error reporting: An integrative literature review

OBJECTIVE

This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER.

METHOD

This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.

RESULTS

Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management.

CONCLUSION

Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.

Nurses' Decisions in Error Reporting and Disclosing Based on Error Scenarios: A Mixed-method Study

Background: It is ensured that nurses’ error reporting and disclosing improve services to patients and are considered a movement toward creating a culture of transparency in the healthcare system. Objectives: This study aimed to investigate the nurses' decisions on reporting and disclosing Medical Errors (MEs). Methods: This research followed a mixed-method embedded design that was performed in five hospitals in Iran in 2018. A total of 491 nurses participated in the quantitative phase of the study with stratified sampling, followed by a simple random sampling technique. Also, 22 nurses joined the qualitative phase. Data were collected using a researcher-made questionnaire and semi-structured interviews through a scenario-based method. Quantitative data analysis was performed using descriptive and analytical statistics by SPSS 21.0 and Expert Choice 10.0 software. The qualitative data were analyzed based on the content analysis approach. Results: The most important perceived barriers with the highest impact coincided with educational (57.17%) and motivational (56.77%) factors based on SEM analysis (ES: 1.33, SE: 0.16). Regression analysis showed that error-reporting mechanisms, educational factors, and reporting consequences were significantly associated with age, sex, and work experience (P-Value ≤0.05). Error scenarios were thematized into three categories: Error perception (including ambiguity and weakness in error definition, the severity of the error, unawareness of guidelines, deviation from standards, and untrained staff), error reporting (including ineffective reporting system, hesitation in reporting to a formal system, increased workload, improper reaction, punitive responses, and concerns about consequences), and error disclosure (including no disclosure, partial disclosure, and full disclosure). Conclusions: The obtained results contributed to a better understanding of the barriers to error reporting and disclosing. In addition, these results can help hospitals encourage error reporting and ultimately make organizational changes, which reduce the incidence of errors.

Korean physicians' perceptions regarding disclosure of patient safety incidents: A cross-sectional study

The present study investigated physicians' perceptions regarding the need for, effects of, and barriers to disclosure of patient safety incidents (DPSI). An anonymous online questionnaire survey was conducted to investigate physicians' perception regarding DPSI, in particular of when DPSI was needed in various situations and of methods for facilitating DPSI. Physicians' perceptions were then compared to the general public's perceptions regarding DPSI identified in a previous study. A total of 910 physicians participated. Most participants (94.9%) agreed that any serious medical error should be disclosed to patients and their caregivers, whereas only 39.8% agreed that even near-miss errors, which did not cause harm to patients, should be disclosed. Among the six known effects of DPSI presented, participating physicians showed the highest level of agreement (89.6%) that "DPSI will lead physicians to pay more attention to patient safety in the future." Among six barriers to DPSI, participants showed the most agreement (75.9%) that "It is unreasonable to demand DPSI in only the medical field, and disclosure is not actively conducted in other fields." With respect to methods for facilitating DPSI, participants agreed that "A guideline for DPSI is needed" (91.2%) and "Manpower to support DPSI in hospitals is required" (89.1%). Meanwhile, 79.3% agreed that "If an apology law is enacted, physicians will perform more DPSI" and 72.4% that "I support the introduction of an apology law." Korean physicians generally have a positive perception of DPSI, but less than the general public.

Factors affecting nursing error communication in intensive care units: A qualitative study

BACKGROUND

Error communication includes both reporting errors to superiors and disclosing their consequences to patients and their families. It significantly contributes to error prevention and safety improvement. Yet, some errors in intensive care units are not communicated.

OBJECTIVES

The aim of the present study was to explore factors affecting error communication in intensive care units.

DESIGN AND PARTICIPANTS

This qualitative study was conducted in 2019. Participants were 17 critical care nurses purposively recruited from the intensive care units of 2 public hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional content analysis method proposed by Graneheim and Lundman.

ETHICAL CONSIDERATIONS

The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran approved the study (code: IR.IUMS. REC.1397.792). Participants were informed about the study aim and methods and were ensured of data confidentiality. They were free to withdraw from the study at will. Written informed consent was obtained from all of them.

FINDINGS

Factors affecting error communication in intensive care units fell into four main categories, namely the culture of error communication (subcategories were error communication organizational atmosphere, clarity of processes and guidelines, managerial support for nurses, and learning organization), the consequences of errors for nurses and nursing (subcategories were fear over being stigmatized as incompetent, fear over punishment, and fear over negative judgments about nursing), the consequences of errors for patients (subcategories were monitoring the effects of errors on patients and predicting the effects of errors on patients), and ethical and professional characteristics (subcategories were ethical characteristics and inter-professional relationships).

DISCUSSION

The results of this study show many factors affect error communication, some facilitate and some prohibit it. Organizational factors such as the culture of error communication and the consequences of error communication for the nurse and the patient, as well as individual and professional characteristics, including ethical characteristics and interprofessional relationship, influence this process.

CONCLUSION

Errors confront nurses with ethical challenges and make them assess error consequences and then, communicate or hide them based on the results of their assessments. Health authorities can promote nurses' error communication through creating a supportive environment for them, developing clear error communication processes and guidelines, and providing them with education about the principles of ethical practice.

Nurses' Experiences with Disclosure of Patient Safety Incidents: A Qualitative Study

Background

Patient safety incidents trigger conflict between healthcare providers and patients. Patients and families want to hear detailed explanations and apologies from medical staff, but nurses may face difficulties with disclosure of patient safety incidents.

Purpose

To identify nurses’ experiences with disclosure of patient safety incidents.

Methods

Data were collected through in-depth interviews with nine clinical and five head nurses and were analyzed using Colaizzi’s phenomenological method.

Findings

After formulating 18 themes representing nurses’ experiences with disclosure of patient safety incidents, we clustered them into four theme clusters: “mixed responses from patients and families,” “caught in a swirl of negative emotions,” “facing the reality that hinders disclosure,” and “waiting for a breakthrough that would enable disclosure”.

Conclusion

Policies, systems, and culture that help both patients and healthcare professionals should be developed.

The relationship of moral sensitivity and patient safety attitudes with nursing students' perceptions of disclosure of patient safety incidents: A cross-sectional study

Disclosure of patient safety incidents is a healthcare management strategy that primarily involves responding after incidents. We investigated the association between nursing students’ moral sensitivity, attitudes about patient safety, and perceptions of open disclosure of patient safety incidents in Korea. Data were collected from 407 nursing students at four nursing universities using self-reported moral sensitivity, attitudes about patient safety, and perceptions about open disclosure of patient safety incidents as measures. The data were analyzed using t-test, one-way analysis of variance, and a multiple regression. As moral sensitivity and attitudes about patient safety improved, nursing students’ perceptions regarding the open disclosure of patient safety incidents improved significantly. After controlling for gender, grade, and major satisfaction, the effect of changing attitudes about patient safety was greater than that of moral sensitivity for all perceptions of open disclosure. An education and intervention program is needed to improve nursing students’ attitudes about patient safety and promote the open disclosure of patient safety incidents during undergraduate training.