Detection of patient risk by nurses: a theoretical framework.
OBJECTIVE
This paper is a description of a theoretical framework of how nurses detect and interpret patient risk signals in the context of organizational attitudes and procedures related to patient safety.


BACKGROUND
The ability to detect when patients are at increased risk for harm is a challenge faced by nurses worldwide. How nurses are able to discriminate patient risk warning signals from background noise is not well understood. Also, the impact of system-level factors on nurses' signal detection capabilities has not been investigated.


METHODS
Computerized database searches were used to identify nursing, organizational science, and cognitive psychology literature from 1964 to 2009 pertinent to the framework.


CONCLUSIONS
The patient risk detection theory synthesizes concepts of signal detection theory and high reliability theory. Signal detection theory explains the decision-making processes of nurses as they scan for signals of potential patient harm. High reliability theory explains how nurses' signal detection capacities are facilitated when healthcare settings operate as high reliability organizations making patient safety the top priority.


CONCLUSIONS
The patient risk detection theory facilitates understanding of both individual and organizational factors that influence nurses' ability to detect risk in complex healthcare settings. It can be used to guide research on interventions to enhance signal detection by nurses and increase patient safety in today's complex care environments. The theory can also be used to guide design of training programmes that permit nurses to develop practical skills in signal detection.
Despins
Laurel A
LA
Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA. despinsl@health.missouri.edu
Scott-Cawiezell
Jill
J
Rouder
Jeffrey N
JN
D002983:Clinical Competence; D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D019300:Medical Errors / Q000451:nursing / Q000517:prevention & control; D008962:Models, Theoretical; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology / Q000592:standards*; D012306:Risk; D018570:Risk Assessment; D017751:Safety Management; D017603:Signal Detection, Psychological