Having reviewed the literature in relation to error reporting and disclosure it has been identified that there are differences have been to be found that are based upon different workplace settings and work roles as well as other factors. Research relating to safety climate has produced similar results.
There is limited research available with respect to the relationship between safety climate and error reporting. Although not specifically considering the issue of safety climate, the previously cited Korean study found elements related to safety climate. For example 45% of respondents felt staff members were afraid to report mistakes and 10% felt errors were held against them. There were 10.7% of respondents who agreed that finding the person responsible for an error was important. Some (30.8%) indicated they agreed with the statement they were worried their mistakes were kept on file (Kim et al., 2007). Although 70.8% felt informed about errors that occurred, only 52.1% felt that when errors occurred people were given feedback (Kim et al., 2007). These results suggest nurses fear reporting from the perspective of the impact it has upon them as an individual.
Safety culture has been linked to the frequency of event reporting (Kagan & Barnoy, 2008) (Etchegaray & Thomas, 2012; Hutchinson et al., 2009). Higher scores have also been associated with lower incident rates (Kagan & Barnoy, 2008) and fewer medication errors as well as other clinical outcomes such as lower ventilator- associated pneumonia, fewer infections of the bloodstream and reduced length of stay in intensive care units (Colla et al., 2005). However, a more recently published pilot meta-analysis concluded there was no relationship between safety culture and medication error although the authors acknowledge an assessment of methodology was not undertaken as part of this review (Groves, 2014).
Safety culture dimensions are not the only element with a degree of predictive validity. A new measure that is argued predicts intent to disclose error better than other measures of healthcare culture has been developed (Etchegaray, Gallagher,
55 Bell, Dunlap, & Thomas, 2012). This same tool used the safety and teamwork
dimensions of the SAQ but found that these did not predict error disclosure. This study used another method of analysis focusing on mean scores rather than on whether the factor score was high.
The factors that were related to improved error disclosure were general culture and error disclosure trust culture (Etchegaray et al., 2012). Participants with education in disclosure had higher scores for both these factors, a point that supports previous discussion regarding the importance of education (Section 2.14).
Other studies suggest a link between safety climate and error disclosure. A survey of medical staff in the USA found that the summary score from the study was positively associated with both error disclosure and apology (Kronman et al., 2012) A study of culture and open disclosure in Ireland found that staff felt the approach to disclosure was unstructured and 24% of respondents feared litigation (Duffy, 2012). The respondents to this study also highlighted barriers from culture and lack of support for staff as concerns.
Summary
It is clear from the research presented here that nurses and other professionals do not report and disclose all error. Areas of difference have been noted based upon workplace setting, work role and other areas such as education. This is clearly a complex area and not one where a simple linear relationship may be identified. Similar complexity exists in relation to safety climate where differences have been found in relation to many of the same areas. When considering the relationship between safety climate and the reporting and disclosure of error, again, a similar complexity arises.
A large amount of research has been undertaken in relation to error reporting, however there is less available relating to error disclosure. This is evident from the
56 search strategy presented at the commencement of Part II of this chapter. There are some areas where research is lacking, including research in the rural context and research that includes nurses particularly in relation to error disclosure. It has also been highlighted that medication error is both prevalent and a significant cost to the Australian health system.
Although there is information about the occurrence of medication error in the Australian context, little is known about the views of reporting and the disclosure of such errors that occur in rural services, within Australia or globally. Health
workforce data indicates that nurses in rural areas work in a variety of different workplace settings including hospitals, aged care, community and general practice (Australian Institute of Health and Welfare, 2013). Nurses are also actively involved in medication administration (Choo et al., 2010).
Drug -related error was the highest non-operative error detected by the HMPS, the majority of which were the result of wrong dose or therapy or inadequate post therapy follow up (Leape et al., 1991). Reporting data from NSW shows that the medication error is the second highest error type reported (the highest is for falls) (Atkins et al., 2014).
A lack of information in relation to error reporting and disclosure indicates this is an area for future research. Whilst the lack of information is global, the Tasmanian context offers the opportunity to research this issue within a single health system across different settings.
A hypothetical medication error will be used for this research. This reflects the approach taken by several of the studies referred to in this chapter where error scenarios have been used in order to investigate medication error and/or views of reporting and disclosure.
The literature review has indicated that although there may not be a relationship between safety climate and medication error, there is a lack of information
57 available on this issue within the rural context. There is no known research relating to safety climate and views of reporting or disclosure amongst nurses working in rural clinical settings indicating this is an area in need of further research.
Aim of the research
The literature review has established there is limited information available about safety culture amongst nurses working in rural clinical settings. The bulk of the research undertaken uses surveys to measure safety climate, teamwork and other factors. Workplace setting, work role and other factors have been identified as having a potential impact on the level of safety climate. Error reporting, error disclosure and medication error are possibly influenced by these same factors. Clearly, the nature of safety culture is quite complex. An example of that complexity is the possible relationship between safety climate and error reporting and
disclosure. Although some studies suggest there may be a relationship, a recent review found there was none. There are no known studies on this issue that have been undertaken in the rural context.
Thus the aim of this research is to describe the complexity of safety climate of nurses working in rural clinical settings. The research question is: how is safety climate related to views of reporting and disclosure of medication error amongst nurses working in rural clinical settings?
Determining how safety climate influences views of reporting necessitated the collection of information relating to each of safety climate and views of reporting and disclosure. Therefore, to inform the research question the first three research sub-questions were developed. These are:
1. What level of reporting and disclosure of different severity of a hypothetical medication error do nurses in rural clinical settings think is occurring?
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2. What is the nature of workplace safety climate amongst nurses in such settings?
3. What is the relationship between workplace safety climate amongst nurses in rural clinical settings and their views of reporting/disclosure of a
hypothetical medication error?
These three sub-questions identify that the research will be conducted in rural clinical settings amongst nurses. They also clarify that the research relates to safety climate, error reporting and error disclosure.