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

倾听患者的声音：与护士对少数族裔和其他健康差异人群的住院患者所表达的安全担忧的判断相关的患者、护士和事件特征

• 批准号: 10631102
• 负责人: Patricia Groves
• 金额: $ 23.84万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-31 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10631102
• 关键词: Address; Adult; Adverse event; Age; American Hospital Association; Awareness; Caring; Characteristics; Communication; Complex; Country; Data; Demographic Survey; Development; Discipline of Nursing; Disparity; Disparity population; Documentation; Environment; Ethnic Origin; Evaluation; Event; Feedback; Foundations; Gender; Goals; Health Personnel; Healthcare; Hospital Nursing; Hospital safety; Hospitalization; Hospitals; Income; Inequity; Injury; Inpatients; Intervention; Intervention Studies; Iowa; Judgment; Learning; Linear Models; Location; Mediating; Medical Errors; Medication Errors; Methods; Minority; Minority Groups; Modeling; Nurses; Nursing Education; Observational Study; Participant; Patients; Play; Population; Provider; Race; Reporting; Research; Research Personnel; Research Project Grants; Residencies; Risk; Role; Safety; Sampling; Sex Orientation; Shapes; Socioeconomic Status; Strategic Planning; Survey Methodology; Surveys; System; Team Nursing; Testing; Training; Training and Education; United States National Institutes of Health; Voice; design; disparity reduction; experience; experimental study; health care service organization; health disparity populations; health equity; implicit bias; improved; innovation; member; patient safety; practice setting; prevent; programs; psychologic; recruit; response; risk mitigation; safety outcomes; satisfaction; therapy development; tool; unethical

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.

项目概要摘要 这项创新研究将通过以下方式解决患者安全和减少健康差异人群中的医疗错误问题： 检查护士评估患者的安全问题。医院中的患者面临因病受伤的风险， 医院环境和医护人员缺乏识别患者安全风险和常见事件。 患者常常依赖护士向医生报告他们表达的安全担忧。 组织的事件报告系统（OIRS）以进行进一步的行动和学习这可能是有问题的。 因为患者必须依靠护士的判断来判断他们的安全担忧是否有效 如果护士认为患者的担忧不可信或不可信，应向 OIRS 报告以采取进一步行动。 重要的，或者不通过 OIRS 报告患者的安全问题，安全可能会因缺乏 护士的即时反应和组织的长期反应 有证据表明护士可能会做出反应。 护士对患者安全严重性的判断存在偏见。 担忧以及他们随后关于是否报告这些担忧的决定可能会受到这种可能隐含的影响 然而，我们对影响护士判断的因素或影响程度知之甚少。 这可能会导致患者安全问题报告的差异 本研究的长期目标。 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、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， 允许组织快速响应安全问题。这项基础研究的目的是 1) 确定。 偏见在护士对患者安全问题的反应中所扮演的角色；2) 确定影响患者安全问题的因素 护士偏见与他们对患者安全问题的反应之间的关系 我们将招募 240 名成年人。 来自四个州的住院护士进行了这项定量、横断面析因调查实验。 将使用在线因子小插图调查来收集调查数据，以模拟患者的场景 参与者将 1) 阅读八个小插图，每个小插图包括患者和患者的组合。 事件特征级别，2) 回答有关插图的问题，以及 3) 完成人口统计调查。 我们将使用多级线性模型来研究变量之间的关系。 完成这个探索性和发展性研究项目将产生一个模型，说明 患者特征、事件特征、护士可信度判断之间的关系 重要性，以及护士通过 OIRS 传达患者关切的意图。 通过制定有针对性的干预措施来提高患者安全、降低风险和防止错误是必要的 支持 a) 护士和患者之间就安全问题进行公开、公正的沟通， b) 让组织能够快速做出反应 未来的研究将包括测试干预措施，例如护士。 住院医师培训计划模块可解决护士与差异人群之间的沟通差距。