Sep 21 2012
By Sarah Guy, medwireNews Reporter
Identifying personal obstacles that prevent nurses speaking up in situations where a patient's safety may be at risk is vital to increasing their perception of collaboration in the work environment, suggest US researchers.
The study used an educational intervention involving discussion of real-life patient scenarios where nurses could have spoken up to impact patient safety, identifying nurses' own obstacles to doing so, and implementing a personal action plan targeting these obstacles.
"The American Association of Critical-Care Nurses recommends that nurses be relentless in pursuing and fostering true collaboration as part of the solution to reducing preventable medical errors," explain Michelle Sayre (Arrowhead Regional Medical Center, Colton, California) and colleagues.
A necessary, but frequently missing, ingredient in this is effective communication, they add in the Journal of Nursing Administration.
Nurses from two acute care centers took part in the study, and were randomly assigned to the intervention, involving discussion of patient scenarios, followed by a commitment of support from chief nurse executives in the unit, and the commitment of the nurse to implement behaviors identified on the action plan, or to a control group with no intervention.
Participants completed three questionnaires at study initiation and again after 1 to 2 months, to assess demographic information, to measure their intention to share views and opinions (the Speaking-Up Measure), and to measure their intention to practice assertiveness and cooperation during problem resolution (Collaborative Practice Scales [CPS]).
While the control group was significantly more likely to speak up at baseline than the intervention group, there were no significant between-group differences in the CPS scores, report the researchers.
However, there was a significant increase in scores on the Speaking-Up Measure between baseline and postintervention in the intervention group, and no such differences in the control group. This association remained after controlling for baseline score differences, say Sayre et al.
Furthermore, the CPS score significantly increased in the intervention group between baseline and postintervention, but was unchanged in the control group. This association also remained true after adjustment.
"Culture change must include hospital leaders expressing and demonstrating support for registered nurses who speak up when patient safety may be in jeopardy," suggest Sayre and co-investigators, adding that an important aspect of true collaboration may lie with each individual nurse as he or she overcomes personal obstacles.
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