How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors

Abstract

Errors in nursing practice are a growing concern in healthcare posing a threat to patient safety. Practitioners have been hesitant to come forward and report errors because of negative ramifications in the workplace. Few studies have approached error management through the eyes of the clinician or have studied how nurses cope or change their practice after committing an error. Studies on nursing errors have traditionally used floor/unit nurses as the sample population.

This study used an often unseen and highly specialized group known as perioperative or operating room registered nurses. This study was a descriptive, correlational design using a survey to obtain information. Perioperative registered nurses (N=272) who were members of the Association of periOperative Registered Nurses (AORN) participated in the study. From this sample, 158 participants admitted to committing an intraoperative nursing error. The conceptual framework that guided this study was Lazarus and Folkman's (1984) cognitive theory of psychological stress and coping.

Results showed that nurses who used accepting responsibility as a coping strategy after committing an error tended to experience high levels of emotional distress (r = .55, p = .000). Relationships were shown between the strategy of planful problem solving with constructive changes in practice (r = .34, p = .000), and the strategy of escape-avoidance with defensive changes in practice ( r = .52, p = .000). Using multiple regression analysis, the strategies of accepting responsibility (β = .34, p < .001) and using self-control (β = .17, p < .05) were found to be significant predictors of emotional distress. Seeking social support (β = .20, p < .05) and planful problem solving (β = .29, p < .001) emerged as significant predictors of constructive changes in practice. The most predictive of defensive changes was the strategy of escape-avoidance (β = .35, p < .001).

Outcomes that are identified from the process of error management should include measures intended to promote learning from the error and interventions designed to prevent future errors. This study provided evidence that perioperative nurses experienced a variety of emotions after committing an error which led to alterations in the way they practiced.