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Nurses’ perspectives and medical errors

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

By Stuart McLennan, Martin Diebold, Leigh E. Rich, and Bernice S. Elger

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. 

Read the full article

McLennan, Stuart, Martin Diebold, Leigh E. Rich, and Bernice S. Elger. 2016. Nurses’ perspectives regarding the disclosure of errors to patients: A qualitative study. International Journal of Nursing Studies 54: 16–22.

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