Paper
Wednesday, July 11, 2007
This presentation is part of : Qualitative Inquiry and Patient Safety: Developing a Deeper Understanding of What We Say, What We Do and Why it Matters
Transdisciplinary Perspectives on Near Misses in the Health Care Setting
Lianne Jeffs, RN, MSc, Nursing Administration, St. Michael's Hospital, Toronto, ON, Canada and Dyanne Affonso, RN, PhD, College of Nursing, University of Hawaii, Hilo, HI, USA.

Near misses are important events in everyday clinical practice and are associated with patient care vulnerabilities and their frequency in occurrence compared to adverse events. Current gaps in the literature around near misses include: variation in how near misses are defined, limited data on contributing factors affecting caring processes, and lack of knowledge of mitigating strategies. This qualitative study was conducted to address the identified gaps and had the following research objectives: 1) obtain definitions of a near-miss event that occurred in clinical practice environments; 2) identify descriptors of the meanings that near-miss events; 3) obtain clinical examples; and identify how health care professionals and consumers can reconcile near misses. Nine health care organizations (13 sites total) including six academic health sciences centres (acute care, mental health, and geriatric) and three community hospitals participated in this study. The final sample consisted of 37 focus groups (nurses and pharmacists) and 120 key informant interviews involving 144 health care consumers. A multi-level content analyses schema (transcription, coding, categorizing, internal consistency, thematic analysis, and community validation) was used. For this session, the points of convergence and divergence perspectives from the different stakeholder groups including nurses (clinical, educators, advanced practice and administrators), pharmacists/pharmacist technicians, and patient and family members) that were part of the transdisciplinary team will be highlighted. Within this discussion an overview of the data that emerged from the multi-level analytical phases (coding and categorizing) and how reconciliation at the thematic level of analysis will be provided. Study findings implicate changes for the health care landscape relative to transdisciplinary care and contexts and offer insights into future scholarly inquiry. Of particular interest are the overall implications for promoting a practice environment that reconciles differences in perspectives and enables synergy amongst the health care team in the provision of patient care.