目的:为了测试患者的影响,安全事件和护士特征对护士可信度的判断,报告患者安全问题的重要性和意图。
方法:因子调查实验。
方法:共招募了240名护士,并完成了一项在线调查,包括人口统计学信息和对8个因素的回答,这些因素包括8个患者和事件因素的独特组合。采用层次多因素分析检验小插图因素和护士特征对护士判断的影响。
结果:护士判断的组内系数表明,护士之间的差异超过了上下文插图因素的影响。确定了几个重要的护士变异来源,包括种族/民族,提示护士的特征和他们潜在的偏见之间的复杂关系,以及个人和患者因素对护士判断的影响,包括报告安全问题的决定。
结论:护士是管理患者安全问题的系统中的关键角色。护士之间的差异以及他们如何应对患者安全问题的情景突出了护士级别干预的必要性。
■影响护士判断的复杂因素,患者安全问题的解释和报告。
结论:了解护士对患者表达的安全问题的判断对于设计促进报告的流程和系统至关重要。多事件和患者特征(事件类型和明显伤害,和病人的性别,种族/民族,社会经济地位,和沟通方式)以及参与者特征(种族/民族,性别,多年的经验和基层医院区域)影响了参与者对可信度的判断,关注程度和报告意图。这些发现将有助于指导患者安全护士的教育和培训。
■STROBE指南。
■公众,包括耐心的倡导者,参与了小插图场景的内容验证,规范析因调查中使用的照片,并测试调查功能。
OBJECTIVE: To test the influences of patient, safety event and nurse characteristics on nurse judgements of credibility, importance and intent to report patients\' safety concerns.
METHODS: Factorial survey experiment.
METHODS: A total of 240 nurses were recruited and completed an online survey including demographic information and responses to eight factorial vignettes consisting of unique combinations of eight patient and event factors. Hierarchical multivariate analysis was used to test influences of vignette factors and nurse characteristics on nurse judgements.
RESULTS: The intraclass coefficients for nurse judgements suggest that the variation among nurses exceeded the influence of contextual vignette factors. Several significant sources of nurse variation were identified, including race/ethnicity, suggesting a complex relationship between nurses\' characteristics and their potential biases, and the influence of personal and patient factors on nurses\' judgements, including the decision to report safety concerns.
CONCLUSIONS: Nurses are key players in the system to manage patient safety concerns. Variation among nurses and how they respond to scenarios of patient safety concerns highlight the need for nurse-level intervention.
UNASSIGNED: Complex factors influence nurses\' judgement, interpretation and reporting of patients\' safety concerns.
CONCLUSIONS: Understanding nurse judgement regarding patient-expressed safety concerns is critical for designing processes and systems that promote reporting. Multiple event and patient characteristics (type of event and apparent harm, and patient gender, race/ethnicity, socioeconomic status, and communication approach) as well as participant characteristics (race/ethnicity, gender, years of experience and primary hospital area) impacted participants\' judgements of credibility, degree of concern and intent to report. These findings will help guide patient safety nurse education and training.
UNASSIGNED: STROBE guidelines.
UNASSIGNED: Members of the public, including patient advocates, were involved in content validation of the vignette scenarios, norming photographs used in the factorial survey and testing the survey functionality.