title: Nurses' perspectives regarding the disclosure of errors to patients: A qualitative study.
abstract: BACKGROUND
  There is often a mismatch between patients' desire to be informed about errors and clinical reality. In closing the "disclosure gap" an understanding of the views of all members of the healthcare team regarding errors and their disclosure to patients is needed. However, international research on nurses' views regarding this issue is currently limited.
  
  
  OBJECTIVE
  Explore nurses' attitudes and experiences concerning disclosing errors to patients and perceived barriers to disclosure.
  
  
  METHODS
  Inductive, exploratory study employing semi-structured interviews with participants, followed by conventional content analysis in which investigators read and discussed transcribed data to identify important themes.
  
  
  METHODS
  Nursing departments from hospitals in two German-speaking cantons in Switzerland.
  
  
  METHODS
  Purposive sample of 18 nurses from a range of fields, positions in organisational hierarchy, work experience, hospitals, and religious perspectives.
  
  
  METHODS
  Data were collected via individual, face-to-face interviews using a researcher-developed semi-structured interview guide. Interviews were transcribed in German and analysed using the qualitative data analysis software package Atlas-Ti (Berlin) and conventional content analysis. The most illustrative quotes were translated into English.
  
  
  RESULTS
  Nurses generally thought that patients should be informed about every error, but only a very few nurses actually reported disclosing errors in practice. Indeed, many nurses reported that most errors are not disclosed to the patient. Nurses identified a number of barriers to error disclosure that have already been reported in the literature among all clinicians, such as legal consequences and the fear of losing patients' trust. However, nurses in this study more frequently reported personal characteristics and a lack of guidance from the organisation as barriers to disclosure. Both issues suggest the need for a systematic institutional approach to error disclosure in which the decision to inform the patient stems from within the organisation and is not shouldered by individual nurses alone.
  
  
  CONCLUSIONS
  Our study suggests that hospitals need to do more to support and train nurses in relation to error disclosure. Such measures as hospitals establishing a disclosure support system, providing background disclosure education, ensuring that disclosure coaching is available at all times, and providing emotional support for all parties involved, would likely go a long way to address the barriers identified by nurses.
authors.affiliation: Institute for Biomedical Ethics, Universität Basel, Basel, Switzerland. Electronic address: s.mclennan@unibas.ch.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: McLennan
authors.affiliation: Institute for Biomedical Ethics, Universität Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Diebold
authors.affiliation: Department of Health Sciences, Armstrong Atlantic State University, Savannah, GA, USA.
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Rich
authors.affiliation: Institute for Biomedical Ethics, Universität Basel, Basel, Switzerland.
authors.forename: Bernice S
authors.initials: BS
authors.lastname: Elger
mesh_terms: D004506:Education, Nursing; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009726:Nurses / Q000523:psychology*; D014342:Truth Disclosure
keywords: Attitudes; Communication barriers; Medical errors; Nurses; Qualitative research; Switzerland