Brazilian registered nurses’ perceptions and attitudes towards adverse events in nursing care: a phenomenological study

Cancer nurses' perspective of error disclosure from nurses to patients: A qualitative descriptive study

PURPOSE

This study aims at exploring Cancer Nurses' Perspective of Error Disclosure.

METHODS

This qualitative descriptive study was conducted in 2022, Iran. Data collection methods included observation (121 h), and semi-structured interviews (12 interviews with nurses, and nursing managers). Data analysis was performed using Graneheim and Lundman's approach. This study obtained ethical approval from Ethics Committee of Isfahan University of Medical Sciences. The COREQ checklist was used for study report.

RESULTS

Data analysis resulted in three categories and nine subcategories: Error disclosure as a professional necessity (error disclosure as one of the patient's rights and error disclosure for self-and peer-learning), Error disclosure barriers (cancer-related factors, individual deterrents, nurses' intragroup culture, and organizational deterrents) and Error disclosure facilitators (culture of transparency, managerial support for error disclosure and development of error disclosure protocol).

CONCLUSION

Creating a culture of error disclosure requires removing barriers, and providing facilitators. By reevaluating their professional performance and responsibilities, nurses may help foster a culture of error disclosure, and managers can do the same by encouraging employees and creating a clinical error disclosure manual. The promotion of an error disclosure to the patient culture may be greatly aided by managers. They facilitate this role by providing practical guidance (based on Iranian culture, needs and conditions of cancer patients and their families) to address nurses' concerns about managers' and the organization's negative responses.

Health care professionals' attitudes regarding patient safety: cross-sectional survey

BACKGROUND

Patient safety is being seen as an increasingly important topic in the healthcare fields, and the rise in numbers of patient safety incidents poses a challenge for hospital management. In order to deal with the situation, it is important to know more about health care professionals' attitudes regarding patient safety. This study looks to describe health care professionals' attitudes regarding patient safety, and whether differences exist based on the background factors of study participants.

METHODS

A quantitative study using a questionnaire was conducted in three multi-disciplinary hospitals in Western Lithuania. Data was collected in 2014 from physicians, nurses and nurse assistants.

RESULTS

The results showed positive safety attitudes, and these were especially related to the respondents' levels of job satisfaction. A respondent's older age was associated with how they evaluated their teamwork climate, safety climate, job satisfaction, and perception of management. Profession, working unit, length of work experience, information received about patient safety during education, further education, and working shifts were all associated with several safety attitude areas.

CONCLUSIONS

The safety attitudes of respondents were generally found to be positive. Attitudes related to patient safety issues were positive among health care professionals and opens the door for the open discussion of patient safety and adverse events. However, in future we also need to investigate the knowledge and skills professionals have in relation to patient safety, in order to gain a deeper understanding of the present situation.

Nurses' perspectives regarding the disclosure of errors to patients: A qualitative study

BACKGROUND

There is often a mismatch between patients' desire to be informed about errors and clinical reality. In closing the "disclosure gap" an understanding of the views of all members of the healthcare team regarding errors and their disclosure to patients is needed. However, international research on nurses' views regarding this issue is currently limited.

OBJECTIVES

Explore nurses' attitudes and experiences concerning disclosing errors to patients and perceived barriers to disclosure.

DESIGN

Inductive, exploratory study employing semi-structured interviews with participants, followed by conventional content analysis in which investigators read and discussed transcribed data to identify important themes.

SETTINGS

Nursing departments from hospitals in two German-speaking cantons in Switzerland.

PARTICIPANTS

Purposive sample of 18 nurses from a range of fields, positions in organisational hierarchy, work experience, hospitals, and religious perspectives.

METHODS

Data were collected via individual, face-to-face interviews using a researcher-developed semi-structured interview guide. Interviews were transcribed in German and analysed using the qualitative data analysis software package Atlas-Ti (Berlin) and conventional content analysis. The most illustrative quotes were translated into English.

RESULTS

Nurses generally thought that patients should be informed about every error, but only a very few nurses actually reported disclosing errors in practice. Indeed, many nurses reported that most errors are not disclosed to the patient. Nurses identified a number of barriers to error disclosure that have already been reported in the literature among all clinicians, such as legal consequences and the fear of losing patients' trust. However, nurses in this study more frequently reported personal characteristics and a lack of guidance from the organisation as barriers to disclosure. Both issues suggest the need for a systematic institutional approach to error disclosure in which the decision to inform the patient stems from within the organisation and is not shouldered by individual nurses alone.

CONCLUSIONS

Our study suggests that hospitals need to do more to support and train nurses in relation to error disclosure. Such measures as hospitals establishing a disclosure support system, providing background disclosure education, ensuring that disclosure coaching is available at all times, and providing emotional support for all parties involved, would likely go a long way to address the barriers identified by nurses.

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Background

In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.

Aim

The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS.

Methods

This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure.

Results

A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance.

Conclusions

There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The contribution of nurses to incident disclosure: a narrative review

OBJECTIVES

To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure.

DESIGN

A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review.

DATA SOURCES

A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact.

REVIEW METHODS

The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis.

RESULTS

The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing.

CONCLUSIONS

Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.