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Getting the truth : a qualitative comparative analysis of rural nurses' attitude to safety climate and their views of reporting a hypothetical medication error

Carnes, DM (2015) Getting the truth : a qualitative comparative analysis of rural nurses' attitude to safety climate and their views of reporting a hypothetical medication error. PhD thesis, University of Tasmania.

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Interventions to prevent error and improve error management have been central to
health care safety and quality research. To achieve this, any error needs to be reported
formally and should also be acknowledged to the patient/consumer or their family.
Appropriate organisational culture is regarded as a means of assisting these actions.
Error management is important to the health system, clinicians and most importantly for
consumers. When an error occurs it can lead to harm, which itself can be traumatic, but
this in turn can lead to increased costs both to the system and to the consumer.
Clinicians involved in error, along with their colleagues, also suffer when harm occurs as
a result of error. Most importantly, the consumer and/or their family suffer, including if
the facts of an error are not fully disclosed.
This research aims to describe the complexity of safety climate amongst nurses working
in rural clinical settings. It focuses on the nature of this complexity in relation to nurses’
views of reporting medication error.
The framework for the research was underpinned by complexity science with health
care viewed as a complex system where evidence and sense-making are forms of
knowledge generation. A survey incorporating a safety attitudes questionnaire and a
hypothetical medication error with multiple outcome scenarios (severe, moderate and
near miss error) was used to collect data for this research. Variable analysis was
undertaken along with case-based analysis using a configurational comparative method
(CCM). This provided an additional means of analysing the data with each individual
nurse considered a case.
Variable analysis found differences in both views of reporting and disclosure as well as
safety climate and teamwork factors amongst reporting compared with disclosure,
severity of harm from the error, workplace setting and work role. The results from the
case-based configurations of factors of safety climate present for the outcomes in each
of these areas also demonstrated complexity existed in the relationship between the
factors and views.
Some of these configurations suggest common assumptions made about culture and
error reporting are not fully consistent with an outcome that an error would always be
viewed as reported or acknowledged by each individual nurse. These assumptions need
to be rethought, particularly those surrounding positive safety climate factors as being
causal for improvements in error reporting and disclosure.
The case-based results also had implications for the concept of resilience. They suggest a
need for more focus upon why error is reported and disclosed rather than looking
primarily at why it is not occurring. Error management should be regarded as an
intervention for safe patient care rather than an outcome of positive safety climate. In
this way resilience to safety climate may be achieved.
Use of a configurational comparative method has provided for better understanding of
safety climate and error within the complex and chaotic world in which health care
delivery occurs. Shifting from a focus upon reductive approaches to research, that are
driven by evidence, to one of expanding knowledge and sense-making helps with
understanding the world of clinical practice where nurses work, and consumers receive
health care. This informs both future research as well as the development of new
theories for the delivery of safe patient care.

Item Type: Thesis (PhD)
Keywords: medication error, safety climate, error reporting, error disclosure, rural nursing, qualitative comparative analysis
Copyright Information:

Copyright 2015 the Author

Date Deposited: 10 Nov 2016 05:03
Last Modified: 10 Nov 2016 05:03
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