Heeding patient voices: Patient, nurse, and event characteristics associated with nurse judgments about safety concerns conveyed by inpatients in minority and other health disparity populations

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Project Summary Abstract This innovative study will address patient safety and medical error reduction in health disparity populations by examining nurse evaluation of patients’ safety concerns. Patients in hospitals are at risk of injury from illness, hospital environment, and healthcare workers. Identification of patient safety risks and events frequently lacks the critical patient perspective. Patients often rely on nurses to report their expressed safety concerns to the organization’s incident reporting system (OIRS) for further action and learning. This can be problematic because patients must rely on their nurse’s judgment about whether their safety concerns are valid and should be reported to the OIRS for further action. If nurses do not judge the patient’s concern as credible or important, or do not report the patient’s safety concern through the OIRS, safety can suffer through lack of both immediate nurse response and long-term organizational response. There is evidence that nurses may be biased against certain patient characteristics. Nurses’ judgments about the seriousness of patients’ safety concerns and their subsequent decisions about whether to report them may be subject to such likely implicit biases. However, very little is known about the factors that influence nurse judgments or the extent to which this may lead to disparities in the reporting of patient safety concerns. The long-term goal of this research program is to improve patient safety, mitigate risks, and prevent errors by developing targeted interventions that support open and unbiased communication between nurses and patients about safety concerns and allow organizations to respond rapidly to safety concerns. Aims of this foundational study are to 1) Determine the role bias plays in nurses’ responses to patient safety concerns and 2) Identify factors influencing the relationship between nurses’ biases and their responses to patient safety concerns. We will recruit 240 adult inpatient hospital nurses from four states for this quantitative, cross-sectional factorial survey experiment. We will collect survey data using an online factorial vignette survey to simulate scenarios in which patients express safety concerns. Participants will 1) read eight vignettes, each including combinations of patient and event characteristic levels, 2) answer questions about the vignettes, and 3) complete a demographic survey. We will investigate hypothesized relationships among variables using multilevel linear models. Successful completion of this exploratory and developmental research project will result in a model illustrating the relationships among patient characteristics, event characteristics, nurse judgments of credibility and importance, and nurse intent to communicate patient concerns through the OIRS. This foundation is necessary to improve patient safety, mitigate risks, and prevent errors by developing targeted interventions that support a) open and unbiased communication between nurses and patients about safety concerns and b) allow organizations to rapidly respond. Future research will include testing interventions such as nurse residency program modules to address gaps in communication between nurses and disparity populations.