title: The contribution of nurses to incident disclosure: a narrative review.
abstract: OBJECTIVE
  To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure.
  
  
  METHODS
  A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review.
  
  
  METHODS
  A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact.
  
  
  METHODS
  The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis.
  
  
  RESULTS
  The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing.
  
  
  CONCLUSIONS
  Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.
authors.affiliation: Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, England, United Kingdom. Electronic address: reema.harrison@sydney.edu.au.
authors.forename: Reema
authors.initials: R
authors.lastname: Harrison
authors.affiliation: University of York, York, England, United Kingdom.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Birks
authors.affiliation: University of York, York, England, United Kingdom.
authors.forename: Jill
authors.initials: J
authors.lastname: Hall
authors.affiliation: University of York, York, England, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Bosanquet
authors.affiliation: University of York, York, England, United Kingdom.
authors.forename: Melissa
authors.initials: M
authors.lastname: Harden
authors.affiliation: University of Technology, Sydney, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
mesh_terms: D033262:Narration; D009740:Nursing Staff; D061214:Patient Safety; D014342:Truth Disclosure; D035642:Whistleblowing
keywords: Adverse events; Incident disclosure; Medical error; Nurses; Patient safety; Patient safety incidents