Date of Award

9-28-2009

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Ptlene Minick - Committee Chair

Second Advisor

Cecelia Grindel - Committee Member

Third Advisor

Krista Meinersmann - Committee Member

Fourth Advisor

Valerie Fennell - Committee Member

Abstract

The 1999 Institute of Medicine report, To Err is Human, raised awareness about the multitude of errors that occur in healthcare. Frequently, errors are not disclosed to patients or their families. While several studies have examined patient and physician perspectives on disclosure, limited research on nurse perspectives exist. In hospitals, nurses are often the last line of defense before errors reach the patient. Because nurses are often present when errors occur, nurses’ experiences with disclosure are integral to understanding the issues that surround the disclosure of errors. The purpose of this study was to gain an understanding of nurse experiences with both disclosure and non-disclosure of errors to patients. An interpretive approach was used to guide the study, combined with a feminist perspective to illuminate the issues of power and gender. Registered nurses (n=17) employed in hospitals and caring for adult medical/surgical patients participated in semi-structured interviews. After the audio-recorded interviews were transcribed, they were reviewed for accuracy by participants. Analysis consisted of an eight-step process including use of a research team and peer debriefing. Three major themes and 6 sub-themes were identified. Major themes were: (a) disclosing errors, (b) perceiving expectations for disclosure, and (c) not disclosing errors. Some nurses provided constant information to the patient, so a disclosure decision was not necessary when errors occurred. Many of these nurses felt that full disclosure was the right thing to do. Other nurses based disclosure decisions on their perceptions of the culture or policies of the work environment. Disclosing events, but not errors was a method used to vaguely disclose while others overtly concealed errors. Some nurses felt that disclosure was a professional responsibility, while others felt that nurses should align themselves with institutional expectations. Still others indicated that disclosure should be determined on a case-by-case basis depending on the context. This study contributes to nursing science by illuminating the experiences of nurses with disclosure, describing nurses’ ways of being truthful when errors occur, and examining the contextual factors that surround nurses’ practices of disclosure. Recommendations of the study for nursing practice, education and research were identified.

Included in

Nursing Commons

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