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

项目摘要 这项创新研究将通过以下方式解决健康差异人群中的患者安全和医疗错误减少问题： 检查护士对病人安全问题的评估。医院里的病人有生病受伤的危险， 医院环境和医护人员。患者安全风险和事件的识别经常缺乏 危重病人的观点病人经常依靠护士向医院报告他们表达的安全问题。 组织的事件报告系统（OIRS），以进一步采取行动和学习。这可能是有问题 因为病人必须依靠护士的判断，判断他们的安全问题是否有效， 应向OIRS报告以采取进一步行动。如果护士认为病人的担忧不可信， 重要，或者不通过OIRS报告患者的安全问题， 护士的即时反应和组织的长期反应。有证据表明，护士可能 对病人的某些特征有偏见。护士对病人安全严重性的判断 他们的关切和随后关于是否报告的决定可能受到这种可能隐含的影响， 偏见然而，很少有人知道的因素，影响护士的判断或程度， 这可能导致在报告患者安全问题时出现差异。这项研究的长期目标是 该计划旨在通过制定有针对性的干预措施来提高患者安全性，降低风险并防止错误 支持护士和患者之间就安全问题进行公开和公正的沟通， 使组织能够迅速对安全问题做出反应。本基础研究的目的是：1）确定 偏见在护士对病人安全问题的反应中所起的作用; 2）确定影响 护士的偏见和他们对病人安全问题的反应之间的关系。我们将招募240名成年人 来自四个州的住院医院护士进行这项定量，横断面析因调查实验。我们 将使用在线析因小插曲调查收集调查数据，以模拟患者 表达安全担忧。参与者将1）阅读八个小插曲，每个小插曲包括患者和 事件特征水平，2）回答关于小插曲的问题，以及3）完成人口统计调查。 我们将使用多水平线性模型研究变量之间的假设关系。成功 这一探索性和发展性研究项目的完成将产生一个模型，说明 患者特征、事件特征、护士判断可信度和 重要性，以及护士通过OIRS传达患者关注的意图。这个基础是 有必要通过制定有针对性的干预措施来提高患者安全性，降低风险并防止错误 支持a）护士和患者之间关于安全问题的公开和公正的沟通， B）允许组织快速响应。未来的研究将包括测试干预措施，如护士 住院医师计划模块，以解决护士和差距人口之间的沟通差距。

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.