Research Activities, September 2013
How nurses keep patients safe may be better understood through risk management theory
Patient Safety and Quality
Nurses working in hospitals keep their patients safe by risk management, suggests a new study. Interviews with registered nurses (RNs) revealed that the nurses continually assess the clinical environment for possible risks of harm and use their knowledge of potential risks and knowledge of the patient to prevent harm. Successful risk management requires nurses to recognize risks before they reach the patient, constantly prioritize the identified risks, then act to prevent those that would cause the patient the most serious harm.
The researchers based this theory of managing risk on 16 qualitative interviews with 12 female RNs with direct patient care roles (9 in adult acute care, 2 in adult intensive care, and 1 involved in care for both types of patients) at a 247-bed academic medical center in the Midwest. Previous studies on the process of patient safety in hospitals had focused on systemic factors such as organizational reliability, or how an accident penetrates organizational defenses, but not on how nurses behave to reduce the risks of harm to individual patients or how their actions help create the institutional patient safety culture.
In the course of their interviews, the researchers found that the nurse participants perceived that their patients were always at risk. They assessed their patients for common and uncommon risks using their own knowledge and experience to recognize deviations from the norm and to choose an appropriate counteraction. Even if one harm was prevented, another could develop, making the process of protecting patients from harm a repetitive cycle of observation, evaluation, and action.
The researchers suggest more studies that involve both male and female nurses and licensed practical nurses that are conducted in community and academic hospitals to better understand how managing risk can vary. The study was funded by AHRQ (HS21075).
More details are in "It’s always something: Hospital nurses managing risk," by Patricia Groves, Ph.D., R.N., Deborah Finfgeld-Connett, Ph.D., R.N., and Bonnie J. Wakefield, Ph.D., R.N., in the December 2012 online Clinical Nursing Research.