Objectives: Adverse events remain the third leading cause of death in hospitals today, after heart disease and cancer. However, adverse events remain underreported. The purpose of this integrative review is to synthesize adverse event reporting priorities in acute care hospitals from quantitative, qualitative, and mixed-methods research articles.Methods: A comprehensive review of articles was conducted using nursing, medicine, and communication databases between January 1, 1999, and May 3, 2021. The literature was described using standard reporting criteria.Results: Twenty-nine studies met the eligibility criteria. Four key priorities emerged: understanding and reducing barriers, improving perceptions of adverse event reporting within healthcare hierarchies, improving organizational culture, and improving outcomes measurement. Conclusions:A paucity of literature on adverse event reporting within acute care hospital settings was found. Perceptions of fear of blaming and retaliation, lack of feedback, and comfort level of challenging someone more powerful present the greatest barriers to adverse event reporting. Based on qualitative studies, obtaining trusting relationships and sustaining that trust, especially in hierarchical healthcare systems, are difficult to achieve. Given that patient safety training is a common strategy clinically to improve organizational culture, only 4 published articles examined its effectiveness. Further research in acute care hospitals is needed on all 4 key priorities. The findings of this review may ultimately be used by clinicians and researchers to reduce adverse events and develop future research questions.
Objective: Nurses' voluntary reporting of adverse events and errors is critical for improving patient safety. The operationalization and application of the concept, patient safety culture, warrant further study. The objectives are to explore the underlying factor structure, the correlational relationship, between items of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and examine its construct validity.Methods: Exploratory factor analysis was conducted using secondary data from the instrument's database. Using pattern matching, factors obtained through exploratory factor analysis were compared with the 6-component Patient Safety Culture Theoretical Framework: degree of psychological safety, degree of organizational culture, quality of culture of safety, degree of high reliability organization, degree of deference to expertise, and extent of resilience.Results: 6 exploratory factors, explaining 51% of the total variance, were communication lead/speak out/resilience, organizational culture and culture of safety-environment, psychological safety-security/protection, psychological safety-support/trust, patient safety, communication, and reporting for patient safety. All factors had moderate to very strong associations (range, 0.354-0.924). Overall, construct validity was good, but few exploratory factors matched the theoretical components of degree of deference to expertise and extent of resilience.Conclusions: Factors essential to creating an environment of transparent, voluntary error reporting are proposed. Items are needed, specifically focusing on deference to expertise, the ability of the person with the most experience to speak up and lead, despite hierarchy or traditional roles, and resilience, which is coping and moving forward after adversity or mistakes. With future studies, a supplemental survey with these items may be proposed.
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