Speak or shut up: that is the question for nurses
DOI:
https://doi.org/10.33448/rsd-v10i7.16427Keywords:
Communication; Communication barriers; Patient safety; Medical errors.Abstract
Introduction: The way how inter-professional relationships in health are established can generate errors and harm to patients. Objective: examine the nurses' ability to manifest themselves in the face of failures in patient care with the potential for adverse events; and, identify facilitators capable of enhancing the voice of nurses, in the face of ongoing unsafe acts, practiced by health professionals in two hospitals in the metropolitan region of Porto Alegre / RS. Methodology: a multiple and embedded case study was carried out. Data collection between July and August 2020, through semi-structured, virtual, and recorded interviews; for data analysis, the method of analysis of Laurence Bardin was adopted. Results: the ability of nurses to express their concerns related to patient safety depended on some factors in addition to the severity of the damage, such as the personal aspect, the person to be challenged or questioned, the professional (where, approaching the medical team was more difficult than the nursing technician), and the situation or context. Speech enhancers also emerged, mainly: personnel, experience, knowledge, leadership, management, and processes. Conclusion: personal characteristics, such as maturity, and knowledge, helped in decision making, while interdisciplinarity appeared discreetly in the speeches, reinforcing the need for teamwork with this focus, in order to share knowledge and support in uncertainties.
References
Agency for Healthcare Research and Quality. (2017). Estimando os custos adicionais de internação hospitalar e mortalidade associados às condições selecionadas do hospital. AHRQ. https://www.ahrq.gov/professionals/quality-patient-safety/pfp/haccost2017.html.
AHRQ. Agency for Healthcare Research and Quality. (2004). Pesquisa hospitalar sobre cultura de segurança do paciente. Pesquisa Hospitalar Sobre Cultura de Segurança Do Paciente. Rockville: AHRQ. Https://Www.Ahrq.Gov/Sops/Surveys/Hospital/Index.Html. Acesso Em: 12 Jun. 2019.
Bardin, L. (2016). ANÁLISE DE CONTEÚDO (70th ed.).
Brasil Ministério da saúde. (2013). portaria n 529, de01 de abril de 2013, institui o Programa Nacional de segurança do paciente. Brasília(DF): Ministério Da Saúde.
Campbell, A., Sutcliffe, K., Carlstrom, M., Clements, J., Martin, G. P., Dixon-Woods, M., Aveling, E. L., Willars, J., Tarrant, C., Pronovost, P. J., Gillespie, B., Kang, E., Chaboyer, W., Harbeck, E., Steel, C., Fairweather, N., Schwappach, D., Richard, A., Rönnerhag, M., … Outcomes, P. (2019). Speaking up behaviors and safety climate in an Austrian university hospital. BMJ Quality and Safety, 38(1), 1–7. https://doi.org/10.1093/intqhc/mzy089
Cunningham, U., Ward, M. E., De Brún, A., & McAuliffe, E. (2018). Team interventions in acute hospital contexts: A systematic search of the literature using realist synthesis. BMC Health Services Research, 18(1), 1–15. https://doi.org/10.1186/s12913-018-3331-3
Figueiredo, T. W. B., Da Silva, L. A. A., Brusamarello, T., De Oliveira, E. S., Dos Santos, T., & Pontes, L. (2018). Tipos, Causas E Estratégias De Intervenção Frente a Erros De Medicação: Uma Revisão Integrativa. Revista de Enfermagem e Atenção à Saúde, 7(2), 155–175. https://doi.org/10.18554/reas.v7i2.2494
Grade, M. M., Tamboli, M. K., Bereknyei Merrell, S., Mueller, C., & Girod, S. (2019). Attending Surgeons Differ From Other Team Members in Their Perceptions of OR Communication. Journal of Surgical Research, 235, 105–112. https://doi.org/10.1016/j.jss.2018.09.030
Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038–1046. https://doi.org/10.1111/scs.12546
Habermas, J. (1997). Teoría de la acción comunicativa: complementos y estudios previos (Cátedra S.A (ed.); 3°).
Kiesewetter, I., Könings, K. D., Kager, M., & Kiesewetter, J. (2018). Undergraduate medical students’ behavioural intentions towards medical errors and how to handle them: A qualitative vignette study. BMJ Open, 8(3). https://doi.org/10.1136/bmjopen-2017-019500
Kong, L. N., Zhu, W. F., He, S., Chen, S. Z., Yang, L., Qi, L., & Peng, X. (2019). Attitudes towards patient safety culture among postgraduate nursing students in China: A cross-sectional study. Nurse Education in Practice, 38(1), 1–6. https://doi.org/10.1016/j.nepr.2019.05.014
Kowalski, Sonya L. MSN, RN, ACNS-BC; Anthony, Maureen PhD, RN CE, AJN. (n.d.). No Title. American Journal of Nursing, Volume 117(Edição 2), p 34-48. https://doi.org/10.1097 / 01.NAJ.0000512274.79629.3c
Lee, C. T. S., & Doran, D. M. (2017). The Role of Interpersonal Relations in Healthcare Team Communication and Patient Safety: A Proposed Model of Interpersonal Process in Teamwork. The Canadian Journal of Nursing Research = Revue Canadienne de Recherche En Sciences Infirmieres, 49(2), 75–93. https://doi.org/10.1177/0844562117699349
Levine, K. J., Carmody, M., & Silk, K. J. (2020). The influence of organizational culture, climate and commitment on speaking up about medical errors. Journal of Nursing Management, 28(1), 130–138. https://doi.org/10.1111/jonm.12906
Manias, E. (2018). Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opinion on Drug Safety, 17(3), 259–275. https://doi.org/10.1080/14740338.2018.1424830
Martin, G. P., Aveling, E. L., Campbell, A., Tarrant, C., Pronovost, P. J., Mitchell, I., Dankers, C., Bates, D., & Dixon-Woods, M. (2018). Making soft intelligence hard: A multi-site qualitative study of challenges relating to voice about safety concerns. BMJ Quality and Safety, 27(9), 710–717. https://doi.org/10.1136/bmjqs-2017-007579
Morrow, K. J., Gustavson, A. M., & Jones, J. (2016). Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies. International Journal of Nursing Studies, 64, 42–51. https://doi.org/10.1016/j.ijnurstu.2016.09.014
Olde Bekkink, M., Farrell, S. E., & Takayesu, J. K. (2018). Interprofessional communication in the emergency department: residents’ perceptions and implications for medical education. International Journal of Medical Education, 9, 262–270. https://doi.org/10.5116/ijme.5bb5.c111
Pattni, N., Arzola, C., Malavade, A., Varmani, S., Krimus, L., & Friedman, Z. (2019). Challenging authority and speaking up in the operating room environment: a narrative synthesis. British Journal of Anaesthesia, 122(2), 233–244. https://doi.org/10.1016/j.bja.2018.10.056
Raemer, D. B., Kolbe, M., Minehart, R. D., Rudolph, J. W., & Pian-Smith, M. C. M. (2016). Improving anesthesiologists’ ability to speak up in the operating room: A randomized controlled experiment of a simulation-based intervention and a qualitative analysis of hurdles and enablers. Academic Medicine, 91(4), 530–539. https://doi.org/10.1097/ACM.0000000000001033
Rönnerhag, M., Severinsson, E., Haruna, M., & Berggren, I. (2019). A qualitative evaluation of healthcare professionals’ perceptions of adverse events focusing on communication and teamwork in maternity care. Journal of Advanced Nursing, 75(3), 585–593. https://doi.org/10.1111/jan.13864
Schwappach, D., Sendlhofer, G., Kamolz, L. P., Köle, W., & Brunner, G. (2019). Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety. PLoS ONE, 14(9), 1–13. https://doi.org/10.1371/journal.pone.0222461
TartagliaReis, C., Paiva, S., & Sousa, P. (2018). The patient safety culture: A systematic review by characteristics of Hospital survey on patient safety culture dimensions. International Journal for Quality in Health Care, 30(9). https://doi.org/10.1093/intqhc/mzy080
Varallo, F. R., Passos, A. C., Nadai, T. R. de, & Mastroianni, P. de C. (2018). Incidents reporting: barriers and strategies to promote safety culture. Revista Da Escola de Enfermagem Da U S P, 52, e03346. https://doi.org/10.1590/S1980-220X2017026403346
Yin, R.K. (2015). O estudo de caso. Porto Alegre: Bookman.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Carolina Sityá Carús; André Guirland Vieira; Letícia Thomasi Jahnke Botton; Claudio Schubert; Maria Anobes Grespan Fagundes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
