Changes in nursing practice: associations with responses to and coping with errors

To investigate emotional responses of nurses and perceived senior staff responses to errors, error-coping strategies used by nurses and how these are associated with constructive or defensive changes in nursing practice.

Healthcare professionals have generally reported distressing emotional responses to errors and fear concerns about their consequences. However, errors can also be part of a developmental process, by offering opportunities for learning and leading to constructive changes in clinical practice.

Prospective, correlational, multicentre study.

Five hundred and thirty-six structured questionnaires completed from nurses employed in various hospital departments were considered eligible for data extraction. The revised questionnaire used was evaluated for content validity.

Data analysis indicated that positive perceived senior staff responses (p = 0·030), accepting error responsibility (p = 0·031) and seeking social support (p = 0·019) predicted constructive changes in nursing practice, while negative perceived senior staff responses (p = 0·040) and error escape-avoidance (p = 0·041) predicted defensive changes.

Errors promote constructive changes in clinical practice when nurses are encouraged to use adaptive error-coping strategies within a supportive, non-blaming culture.

These findings highlight the role of senior staff in the establishment of a supportive, trustful ward climate, so that nurses can learn from errors, prevent their recurrence and improve patient safety.