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

AIMS AND OBJECTIVE: 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. BACKGROUND: 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. DESIGN: Prospective, correlational, multicentre study. METHODS: 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. RESULTS: 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. CONCLUSIONS: Errors promote constructive changes in clinical practice when nurses are encouraged to use adaptive error-coping strategies within a supportive, non-blaming culture. RELEVANCE TO CLINICAL PRACTICE: 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.