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A Qualitative Study of Nurses

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It is a key organisational aim to ensure clinical incidents are reported, ... Patients coped well with open dialogue. Less likely to take further action ... – PowerPoint PPT presentation

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Title: A Qualitative Study of Nurses


1
A Qualitative Study of Nurses Experience of
Clinical Incident Error Reporting
  • Fiona Donaldson-Myles MSc RGN RM
  • Supervisor of Midwives
  • SSAFA Forces Help

2

3
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4
  • It is a key organisational aim to ensure clinical
    incidents are reported, lessons learned and
    findings disseminated to improve patient care

5
  • A better understanding of how staff feel when
    they have been involved in reporting an error
    will help develop an effective reporting and
    learning culture

6
  • A clinical incident reporting system should
  • Capture adverse incidents and near misses
  • Give staff support and have their confidence.
  • Encourage learning and improve patient safety

7
The second victim - cost of clinical incidents to
carers
  • Doctors
  • Inability to share feelings
  • Feelings of guilt, remorse, helplessness
  • Lack of institutional mechanisms for support
  • Defensive changes

8
The second victim - cost of clinical incidents to
carers
  • Nurses
  • Similar emotions to doctor
  • Better informal support
  • Fearful of arbitrary disciplinary action
  • Mainly medication errors studied

9
Study Aim
  • To obtain and analyse rich data on the experience
    of nurses involved in reporting clinical
    incidents
  • To gain insight into how the process was managed
  • To identify factors that foster a reflective
    environment and give staff confidence to report
    adverse events

10
Methodology
  • Qualitative phenomenological study
  • Participants identified from anonymised first
    person incident reports
  • Informed consent, written information, 3rd party
    introduction
  • Semi-structured interview tool
  • Taped interviews
  • Grounded theory approach

11
Demographic Data of Respondents
  • Number invited to participate 35
  • Number who agreed to participate 18
  • Number of actual participants 15
  • Average age (years) 42
    (range 32 50)
  • Nursing grades
    I -1, H -2, G -3, F -2, E -6, D-1
  • Average years in practice 20
    (range 2 31)
  • Clinical area
    Acute medicine 5

  • Care of elderly 3

  • Community hospital 2

  • Oncology/palliative 2

  • Nurse practitioner 2

  • Specialist nurse 1

12
Six key themes revealed
  • Nurses expectations of management
  • Motivation to report
  • Effects on nurses feelings emotions
  • The need for support
  • Learning from mistakes
  • Views on patient involvement

13
Expectations of Management
  • Nurses felt managerial feedback insufficient
  • Nurses wanted to know if any further action was
    being taken involving them or to prevent
    recurrence
  • Copy of report inadequate
  • Needed closure on episode
  • Did not want copy of report freely available to
    others

14
Expectations of Management
  • They dealt with it at ward level. I am happy
    with that and they said it was the end of the
    matter.
  • I have got a very supportive ward manager, we
    discussed it, I had to write a report to the
    people who deal with risk management and the ward
    manager told me it was the end of the matter.
  • I am hoping that that is it now, and that it is
    finished. I do not know for certain how far
    management are taking it.
  • I suppose no news is good news.

15
Motivation to Report
  • Nurses want to do their best for patients
  • Want to prevent same mistakes happening again
  • Not convinced enough being done in response to
    report
  • Not involved enough in rectifying situation
  • Report can clarify what actually happened

16
Motivation to Report
  • I think it is important to find out why things
    happen
  • It needed to be addressed to prevent the same
    thing happening again
  • Its happened on many occasions since, but it
    doesnt seem to be taken seriously
  • I knew it was a mistake. I was comfortable to
    report it, but I wanted it written down the way
    it really happened

17
Effects on Nurses Feelings and Emotions
  • Thirteen out of fifteen nurses described personal
    impact in very strong terms
  • Used phrases such as
  • feeling sick
  • panic stricken
  • never feeling the same again

18
Effects on Nurses Feelings and Emotions
  • Strong negative feelings regardless of outcome
  • Primary incidents - blamed themselves
  • Secondary incidents - feelings of powerlessness
  • Negative feelings related to
  • type of incident
  • how much early support received
  • Whether still felt trusted by colleagues

19
Effects on Nurses Feelings and Emotions
  • I was absolutely gutted about the thought that I
    had hurt him. He was quite poorly and didnt
    really know, but it still upsets me
  • The patient was not adversely affected, but the
    nurse was absolutely devastated

20
Need for Support
  • Need to talk to someone knowledgeable
  • Explore issues and relieve feelings
  • Face-to-face preferable but telephone and written
    response helped keep feelings in perspective
  • Only nursing / medical family members helpful
  • Inadequate support led to unresolved feelings of
    distress

21
Need for Support
  • I have got a very supportive ward manager. We
    discussed it with her and that was very good.
  • There was nobody I could talk to. My manager
    was not available and everyone was busy. There
    was nobody to give me any reassurance or an
    explanation.
  • I did not have that much support. I mean,
    people realised I wasnt happy, you know, but
    they did not sit me down and say, look, we need
    to talk this over.

22
Suggestions for providing immediate support
  • 24 hour availability of senior nurse / risk
    manager
  • Telephone helpline
  • Protected time for clinical supervision

23
Learning from Mistakes
  • Despite negative feelings, viewed reporting
    process as a learning episode
  • Reassessment / training helped regain confidence
    and trust
  • Became more cautious about tasks taken for
    granted
  • Became more assertive
  • Wanted information regarding tracking trends and
    corporate lessons learned

24
Learning from Mistakes
  • we all make mistakes, we learn, get through them
    and move on
  • I check, check, double check, triple check, Im
    obsessive really now

25
Views on Patient Involvement
  • Nurses felt
  • Errors should be disclosed to patients more
    frequently
  • Patients coped well with open dialogue
  • Less likely to take further action
  • Could contribute to more realistic patient
    expectations

26
Views on Patient Involvement
  • I think it would be nice if the patient got some
    formal feedback. I think an apology or an
    explanation would have been helpful and help
    acknowledge the discomfort and distress he was
    put through.
  • I think I should have told her. Once they know
    the truth and you say you are sorry, on the whole
    they are happy

27
Conclusions
  • Motivation to report was to prevent similar
    occurrence
  • Frustrated by inadequate managerial feedback
  • Supported at ward level, but not higher
  • Strong personal and professional impact
  • Immediate support, clear communication and
    feedback facilitated movement to learning phase
  • Consensus that incidents should be discussed more
    with patients
  • Overwhelmingly rejected system of incident book
    stored on ward

28
Limitations
  • Small study / discrete setting
  • Findings could reflect organisational, regional,
    national characteristics
  • May not be generalisable
  • Participants relatively old and experienced

29
Recommendations
  • More should be done to reduce negative
    psychological and professional impact on nurses
  • Devise a system which gives vital early support
  • 24 hour helpline
  • 24 hour availability of senior nurse/risk manager
  • Extension of clinical supervision
  • Keep nurses informed of organisational action
  • Discontinue incident book system
  • Widen debate on extent to which information on
    errors should be shared with patients

30

SUPPORT AND COMMUNICATION
SUPPORT AND COMMUNICATION
  • SUPPORT AND COMMUNICATION

31
(No Transcript)
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