Introduction: In order to design a safer healthcare system and prevent medical error, it is essential to understand how nurses make decisions. Current nursing clinical decision models include a three step process that includes perceiving the risk, evaluating the risk, and making a decision. While there has been significant research into how nurses make clinical decision, there has been little study regarding what nurses perceive as a risk to patients. This study utilizing focus groups examined what nurses found as risky to patients and what increased and decreased the perception of risk.
Methods: Direct patient care nurses with at least six months’ experience working in an acute, emergency, or intensive care environment were invited to participate in this study. Participants provided demographic data and took part in a 60-90 minute focus group that utilized a semi-structured discussion guide. The focus groups were audio recorded, transcribed verbatim, and checked for accuracy before being qualitatively analyzed using content analysis and constant comparison. Descriptive statistics were utilized for the demographic data.
Results: A convenience sample of twenty-one (21) nurses participated in the focus groups. The six key themes of familiarity vs. uncertainty, war stories, known risks, impact, resources, and nursing actions were identified. The global factors of identifying risk, evaluating risk, and decision emerged from the key themes.
Discussion: The findings from this study confirm previous studies related to both nursing clinical decision making and the power of storytelling. Additionally, this study suggests that nurses may not always identify the risks in the nursing procedures that are familiar resulting in the potential for increased risk of medical errors. The participants were able to identify factors that both increased and decreased the perception of risk in addition to nursing actions that could potentially decrease the risk to patients in common nursing practice situations. This study also suggest that hearing emotionally engaging stories of other nurses has great potential to alter the perception of risk to patients.
|Advisor:||Green, Angela L.|
|Commitee:||Beverly, Claudia, Deshpande, Jayant, Heo, Seongkum, Middaugh, Donna|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 78/12(E), Dissertation Abstracts International|
|Subjects:||Occupational health, Nursing, Health care management|
|Keywords:||Decision making, Nursing, Patient safety, Risk|
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