Open disclosure includes expressing regret for what has happened, keeping the patient informed, and providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event. Open disclosure of patient safety incidents has been proposed as an important system. Nurses experience ethical conflict and stress during open disclosures of patient safety incidents. Moral sensitivity and patient safety attitudes will be required in nurses when they make ethical decisions, such as open disclosure of patient safety incidents. As nursing students are provided with practical responsibilities as nurses after graduation, they have to develop positive attitudes toward and capabilities for patient safety in health care.
This study examines the relationship of nursing students’ moral sensitivity, patient safety attitudes, and perceptions of open disclosure of patient safety incidents.
Methods:
This study was approved by the researcher's university’s institutional review board. Participants were 407 undergraduates from four nursing universities in Korea. The study was conducted from April 30 to May 16, 2018. The general characteristics measured were gender, age, grade, religion, economic status, satisfaction with major (on a 5-point scale). Patient safety attitudes were measured using an instrument developed by Madigosky, Headrick, Nelson, Cox, and Anderson. Moral sensitivity was measured using the Korean Moral Sensitivity Questionnaire (K-MSQ). Nurses’ perceptions of open disclosure of patient safety incidents were measured using a questionnaire modified and supplemented by the researchers, based on Wagner et al.’s study and Kadjian et al.’s study.
The collected data were analyzed using the IBM SPSS 20.0 program. To assess the relationship of moral sensitivity, patient safety attitudes, and perceptions of open disclosure, the Pearson’s correlation coefficient and a multiple regression analysis was performed.
Results:
A. Perceptions of open disclosure of Patient safety incidents
- “Open disclosure should take place when the incident caused serious harm” had the highest mean score in the category of open disclosure across harm levels.
- “Open disclosure will increase medical litigation” had the lowest mean score in the category of negative consequences of open disclosure.
- “Providing guidelines for open disclosure is necessary” had the highest mean score in the category of facilitators of open disclosure.
B. Differences in perceptions of open disclosure of patient safety incidents based on general characteristics
- Perceptions of open disclosure of patient safety incidents (30–120) had a mean score of 95.51. The mean moral sensitivity score (30–120) was 154.92, and the mean patient safety attitudes score (13–75) was 50.84.
- In general characteristics, a statistically significant difference was found only for satisfaction levels with their major. Other variables (gender, age, grade, religion, economic status) were not significant difference.
C. Patient safety attitudes, moral sensitivity, and perceptions of open disclosure of patient safety incidents
- Perceptions of open disclosure of patient safety incidents (30–120) had a mean score of 95.51. The mean moral sensitivity score (30–120) was 154.92, and the mean patient safety attitudes score (13–75) was 50.84.
- There were statistically significant positive correlations between perceptions of open disclosure of patient safety incidents and moral sensitivity (r=.320, p<.001), between perceptions of open disclosure of patient safety incidents and patient safety attitudes (r=.496, p<.001) between moral sensitivity and patient safety attitudes (r=.494, p<.001).
- Statistically significant results were found for moral sensitivity, patient safety attitudes and perceptions of open disclosure (overall: F = 68.509, p<.001, R² = 0.253). Controlling satisfaction with major, patient safety attitudes were statistically significant relationship with perceptions of open disclosure (overall: F = 45.736, p<.001, R² = 0.254).
- The effect of patient safety attitudes was greater than that of moral sensitivity for all perceptions of open disclosure.
Conclusion:
When patient safety attitude was positive, perceptions of open disclosure of patient safety incidents was more favorable. Therefore, creating a positive patient safety culture that can alleviate the negative perceptions of open disclosure are necessary to disclose patient safety incidents effectively. A structured patient safety education program that can develop positive attitudes toward patient safety is needed in the undergraduate curriculum; content on open disclosure of patient safety incidents must be included. It is needed undergraduate nursing programs that foster the ability to empathize and communicate effectively with patients and caregivers in the event of a patient safety incident.