Perceived risk: The impact of real and simulated exposure to adverse events

描述（由申请人提供）：更多的人死于可预防的不良事件（ae），而不是死于乳腺癌或艾滋病。针对这一问题的技术和基于流程的解决方案已经取得了一些成功；然而，人类仍然处于护理的边缘。迫切需要了解和提高人类对可预防的突发事件的适应能力。目前尚不清楚提供者如何感知与可预防的不良事件相关的风险，或如何遵循不良事件预防策略。根据可预防的AE的个人经验，提供者对风险的敏感度更高。研究表明，错过一个事件的后果越大，事件被发现的可能性就越高。较高的预期后果也与更多地采用预防策略有关。本研究的目的包括首先确定那些认为更有可能发生不良事件和后果的个体是否对可能发生的不良事件有更高的关注度，并更坚持采取不良事件预防策略。其次，我们将确定报告的态度和预期行为是否受到先前暴露于ae的影响。最后，我们试图确定我们是否可以通过模拟暴露于可预防的ae以有意义的方式操纵态度和行为。我们能否通过模拟经验来复制可预防的AE的关键背景细节，在不让患者受到伤害的情况下，创造出具有AE个人经验价值的“经验丰富”的专业人员？创造有意义的模拟AE体验所需要的关键情境细节是什么？这种体验如何与引人注目的第三方真实ae故事及其随时间变化的态度、行为和检测性能的后果相比较？长期目标是制定一个可行和有效的教育和/或接触模拟ae的方案，用于卫生保健培训和实践，对态度和行为产生重大和持久的影响，以降低可预防的ae的发生率。我们将通过对Trinity Health护士的大规模调查，探讨先前可预防的AE经历与AE预防态度和意向行为之间的关系。我们将通过设计模拟并在实验室和现场进行测试的迭代过程，评估与模拟可预防的ae以影响态度相关的可行性和关键背景细节。我们将比较不同方法的影响，包括模拟可预防的AE，通过一项涉及博伊西州立大学护理专业学生的实验比较来操纵AE预防态度。该项目的预期结果是更好地了解真实和模拟可预防的不良事件的经验与与不良事件风险和后果以及不良事件预防策略相关的态度之间的关系。我们还将了解可预防AE原位模拟的可行性和可接受性，目的是增加对AE预防策略的关注和依从性。

DESCRIPTION (provided by applicant): More people die from preventable adverse events (AEs) than from breast cancer or AIDS. Technology and process-based solutions to this problem have had some success; however, humans remain at the sharp edge of care. There is a critical need to understand and improve human resilience to preventable AEs. It is not clear how providers perceive risks associated with preventable AEs or follow through with AE prevention strategies. Following personal experience with a preventable AE, providers anecdotally report a greater sensitivity to risks. Research has shown that the greater the perceived consequences associated with missing an event, the higher the likelihood that the event will be detected. Higher perceived consequences are also associated with greater adoption of prevention strategies. The goals of this research involve first determining whether or not individuals who perceive greater likelihood and consequences of AEs report higher levels of attention to possible AEs and greater adherence to AE prevention strategies. Secondly, we will determine whether or not reported attitudes and intended behaviors are influenced by prior exposure to AEs. Finally, we seek to determine whether we can manipulate attitudes and behaviors in a meaningful way through simulated exposure to preventable AEs. Can we, through simulated experiences designed to replicate critical contextual details of preventable AEs, create "seasoned" professionals with the value of personal AE experience, without having exposed a patient to harm? What are the critical contextual details that are required to create a meaningful simulated AE experience? How does such an experience compare to compelling third-party stories of true AEs and their consequences with respect to changing attitudes, behaviors, and detection performance over time? The long-term goal is to develop a feasible and effective program of education and/or exposure to simulated AEs for application in health care training and practice that provides a significant and lasting impact on attitudes and behaviors to decrease rates of preventable AEs. We will explore the relationship between prior preventable AE experience and AE prevention attitudes and intended behaviors through a large-scale survey of Trinity Health nurses. We will evaluate the feasibility and critical contextul details associated with simulating preventable AEs to impact attitudes through an iterative process of designing simulations and testing them in the laboratory and in situ. We will compare the impact of different approaches, including simulation of preventable AEs, to manipulating AE prevention attitudes through an experimental comparison involving nursing students at Boise State University. The expected outcomes of this project are to better understand the relationship between experience with real and simulated preventable AEs and attitudes associated with risks and consequences of AEs and AE prevention strategies. We will also gain understanding related to the feasibility and acceptance of in situ simulation of preventable AEs with the intention of increasing attention and compliance related to AE prevention strategies.