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

描述（由申请人提供）：死于可预防的不良事件（AE）的人数多于死于乳腺癌或艾滋病的人数。基于技术和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AE的复原力。目前尚不清楚医疗服务提供者如何看待与可预防的AE相关的风险或如何贯彻AE预防策略。根据可预防AE的个人经验，提供者对风险的敏感性更高。研究表明，与错过事件相关的感知后果越大，事件被发现的可能性就越高。更高的感知后果也与更多地采用预防策略有关。本研究的目标包括首先确定认为AE可能性和后果更大的个体是否报告了对可能AE的更高关注水平和对AE预防策略的更高依从性。其次，我们将确定报告的态度和预期行为是否受到既往AE暴露的影响。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来以有意义的方式操纵态度和行为。我们是否可以通过模拟经验来复制可预防AE的关键背景细节，从而在不使患者受到伤害的情况下，培养出具有个人AE经验价值的“经验丰富”的专业人员？创建有意义的模拟AE体验所需的关键上下文细节是什么？这种体验与真实AE及其随时间变化的态度、行为和检测性能方面的后果的令人信服的第三方故事相比如何？长期目标是开发一种可行且有效的教育和/或暴露于模拟AE的计划，用于医疗保健培训和实践，对态度和行为产生显著且持久的影响，以降低可预防AE的发生率。我们将通过对Trinity保健护士的大规模调查，探讨既往可预防AE经历与AE预防态度和预期行为之间的关系。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AE影响态度相关的可行性和关键背景细节。我们将通过一项涉及博伊西州立大学护理专业学生的实验比较，比较不同方法（包括模拟可预防的AE）对操纵AE预防态度的影响。本项目的预期结局是更好地了解真实的和模拟的可预防AE的经验与AE风险和后果相关的态度以及AE预防策略之间的关系。我们还将了解原位模拟可预防AE的可行性和可接受性，旨在增加对AE预防策略的关注和依从性。 公共卫生相关性：尽管自2000年国际移民组织报告以来为减少可预防的不良事件作出了努力，但此类事件继续对公共卫生产生重大影响。本研究拟研究医疗服务提供者1）先前暴露于不良事件，2）感知的不良事件风险，3）报告的与不良事件预防相关的态度和行为之间的关系。我们还试图确定暴露于模拟不良事件是否会影响态度和行为，最终可能导致与可预防的不良事件相关的患者和提供者伤害显着减少。

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. PUBLIC HEALTH RELEVANCE: Despite efforts to reduce preventable adverse events since the IOM report in 2000, such events continue to have a significant impact on public health. This research proposes to study the relationship between providers' 1) prior exposure to adverse events, 2) perceived risk of adverse events, and 3) reported attitudes and behaviors associated with adverse event prevention. We also seek to determine whether exposure to simulated adverse events can impact attitudes and behaviors in a way that may ultimately lead to a significant reduction in patient and provider harm related to preventable adverse events.