Exploring the experience of nurse practitioners who have committed medical errors

Abstract

Background and purpose To explore the experience of committing medical error from the perspective of nurse practitioners (NPs). Overall, the purpose of the study is to discern NPs’ behaviors, perceptions, and coping mechanisms in response to having made a medical error. Methods Qualitative research based on two face‐to‐face audio‐recorded semistructured interviews with 10 NPs who had made medical errors in practice. The analysis was guided by concepts in phenomenology. Conclusions During iterative analyses, four overarching themes were identified: (a) The paradox of error victimization, (b) primacy of responsibility and mindfulness, (c) yearning for forgiveness and a supportive other, and (d) coping with a new reality is context dependent. The narratives strongly suggest that NPs who err experience “second victim” phenomena. Implications for practice Reminiscing about the experience of living through an error, NPs shared meaningful insights into their need for a safe environment in which they could candidly share feelings, reflect on the experience, and ascertain the etiology of the mistake. Debriefing in a formal manner might prevent the development of permanent psychological injuries. Hence, inherent to the care of “second victims” is the notion of co‐workers’ fairness, compassion, and recognition of appropriate caring responses that contribute to effective coping and healing.

A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident

“…Of the 10 qualitative studies, one used a grounded theory approach (Crigger & Meek, 2007), and one used a purely descriptive approach (Kable et al, 2018). Four used descriptive phenomenological approaches (Coli et al, 2010; Rassin et al, 2005; Santos et al, 2007; Schelbred & Nord, 2007), and four used interpretive phenomenological approaches (Arndt, 1994; de Freitas et al, 2011; Delacroix, 2017; Treiber & Jones, 2010).…”

“…Five studies explicity focused on medication errors as the type of nursing error (Arndt, 1994; Rassin et al, 2005; Santos et al, 2007; Schelbred & Nord, 2007; Treiber & Jones, 2010). Five studies allowed the nurse to decide what constituted the error of significance in their nursing practice (Coli et al, 2010; Crigger & Meek, 2007; de Freitas et al, 2011; Delacroix, 2017; Kable et al, 2018).…”

“…Most of the semi‐structured qualitative interviews posited the same line of questioning and thus elicited a similar discussion from the study participants (Crigger, 2005; de Freitas et al, 2011; Delacroix, 2017; Kable et al, 2018; Rassin et al, 2005; Santos et al, 2007; Schelbred & Nord, 2007). One open‐ended guide allowed further and deeper interviews, thus eliciting a wider range of responses from participants (de Freitas et al, 2011).…”

“…We agreed this would be coded as feelings of guilt. One study did not explicitly use the word “guilt,” but assigned a main theme as “primacy of responsibility” and chose to use the words “fallibility,” “responsibility,” and “fault” throughout the text instead of “guilt” (Delacroix, 2017). This same method applied to the symptoms of interest, including shame, spiritual‐existential conflict, loss of trust, depression, anxiety, anger, re‐experiencing, self‐harm, and social problems.…”

“…Next, we read entire articles to further rule out evidence that, when further scrutinized, had not met earlier inclusion or exclusion criteria. Limiting studies to those with nurse‐only samples, 21 articles were identified (Arndt, 1994; Chard, 2010; Coli et al, 2010; Crigger & Meek, 2007; de Freitas et al, 2011; Delacroix, 2017; Jones & Treiber, 2010; Kable, Kelly, & Adams, 2018; Kao et al, 2015; Karga, Kiekkas, Aretha, & Lemonidou, 2011; Lewis, Baernholdt, Guofen, & Guterbock, 2015; Maiden, Georges, & Connelly, 2011; Meurier, Vincent, & Parmar, 1997; Quillivan, Burlison, Browne, Scott, & Hoffman, 2016; Rassin et al, 2005; Santos et al, 2007; Schelbred & Nord, 2007; Taifoori & Valiee, 2015; Treiber & Jones, 2010, 2018a, 2018b).…”