Nursing’s Role in Disclosure and Apology

Abstract

Although there is general agreement regarding disclosing adverse events to patients and their families, much of the focus in the literature has been on the physician-patient relationship. Nurses are intimately involved in the day-to-day care of patients and their families. This column explores the role of nurses in disclosure and apology.

Eliciting the Functional Processes of Apologizing for Errors in Health Care

“…Frequently, providers are unsure of what constitutes a medical error or they believe the error is inconsequential resulting in little or no injury to the patient (Cornock, 2011; Gallagher, Studdert, & Levinson, 2007; Roberts, 2007; Wagner et al, 2013). Lack of experience and training in the process of apology and the fear of making things worse creates a “wall of silence,” and withdrawal from providers (Bell et al, 2010; Jeffs et al, 2011; Leape, 2006; Pfrimmer, 2010). Nurses are concerned with being punished or reprimanded, yet medical mistakes are not deliberate and can be difficult to face.…”

“…When apologies are lacking, there is a lack of validation that someone has been harmed. Absence of apology creates feelings of bitterness and anger, causing a broken provider–patient relationship (Bell et al, 2010; Cornock, 2011; Crigger & Meek, 2007; Hébert et al, 2001; Kooienga & Stewart, 2011; Pfrimmer, 2010), compounding feelings of neglect that increases settlement costs (Gallagher et al, 2003; Keogh, 2014; Kooienga & Stewart, 2011; Roberts, 2007). …”

“…Simply saying “I’m sorry” is not apologizing. Empathy is the act of expressing sorrow for the error that has happened; expressing empathy is not an apology in itself (Armstrong, 2009; Pfrimmer, 2010; Roberts, 2007). However, failure to express empathy gives patients the impression that the physician does not care about what happened, and one is not really sorry (Chan et al, 2005; Iedema et al, 2008).…”

“…The apology should never be the only communication with the patient. Lack of communication left patients experiencing fear of the unknown and increased anxiety (Gallagher et al., 2003; Pfrimmer, 2010; Weiss, 2006). …”

“…Apologizing maintains relationships with the victim, restores trust, and reduces anger (Hébert, Levin, & Robertson, 2001; Wu, Huang, Stokes, & Pronovost, 2009). It is an ethical response, a professional standard, and demonstrates respect to the patient (Cornock, 2011; Kaldjian et al, 2006; Pfrimmer, 2010).…”