Iranian nurses’ attitudes towards the disclosure of patient safety incidents: a qualitative study

• Published in: BMJ open Vol. 14; no. 3; p. e076498
• Main Authors: Irani, Parichehr Sabbaghzadeh, Dehghan, Mahlagha, Mehdipour, Roghayeh
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 29-03-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Attitudes; Corporate culture; Disclosure; Documentation; Female; Health & safety; Hospitals, Private; Humans; Iran; Male; Medical errors; Medical ethics; Nurses; Nursing; Patient Safety; PUBLIC HEALTH; Qualitative Research; Safety; Work environment; Iran; PUBLIC HEALTH; Health & safety; Safety
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-076498

ObjectiveStatistics suggests that patients and officials are unaware of a large number of patient safety incidents in healthcare centres. This study aimed to explore the concept of disclosure of patient safety incidents from the perspectives of Iranian nurses.DesignQualitative content analysis.SettingThe study population was nurses working in hospitals affiliated with The Hormozgan University of Medical Sciences, military hospitals and private hospitals in Bandar Abbas, Iran. Sampling was done from January 2021 to September 2021.Participants11 female and 6 male nurses aged 27–59 years with a work experience of 3–34 years were included.Primary and secondary outcome measuresThis qualitative content analysis was to explore the experiences of Iranian nurses (n=17) using purposive sampling and semistructured, in-depth interviews. Maximum variation sampling (age, sex, work experience, education level, type of hospital and type of ward) was considered to obtain rich information. Guba and Lincoln criteria were used to increase the study’s trustworthiness and rigour, and the Graneheim and Lundman method and MAXQDA 2020 were used to analyse data.ResultsWe extracted one theme, four categories and nine subcategories. The main theme was the mental schemas of disclosure of patient safety incidents with four categories: (1) misconceptions of harm to the organisation or self, (2) attributes of the disclosure process and its outcomes, (3) reactions to the disclosing incidents and (4) interpersonal conflicts.ConclusionOur study identified factors influencing the disclosure of patient safety incidents among nurses, including concerns about reputation, fear of consequences and perceptions of the disclosure process. Positive attitudes towards incident disclosure were associated with supportive organisational environments and transparent communication. Barriers to disclosure included patient and companion reactions, misinterpretation and anxiety. Healthcare organisations should foster a non-punitive reporting culture to enhance patient safety and accountability.