A Cognitive Tasks Analysis of Nurses’ Responses to Patient Safety Events When Caring for Children With Medical Complexity at Home

Objectives: To examine factors influencing nurses’ responses during in-home safety events for children with medical complexity (CMC). Methods: We conducted a qualitative study using virtual critical decision method (CDM) interviews with home nurses to elucidate their cognitive process in responding to a safety event. Nurses were asked to describe a medication-related or medical device-related in-home safety event in chronological order, after which we probed for their cognitive processes following an action. Research staff coded interview transcripts to identify factors involved in each nurse’s decision-making process. Thematic analysis was used to identify key themes. Results: We conducted 15 critical decision method interviews with home nurses of CMC. Eighty percent of participants were female, and 67% had worked in the home setting for ≥6 years. Four themes emerged: (1) sufficient formal training and experience specific to caring for CMC supports home nurses’ preparedness to respond to safety events; (2) inconsistent availability of supplies and/or malfunctioning equipment at home can complicate safety event response; (3) limited real-time support and barriers in communication within and between home-based and clinic-based teams can create uncertainty, delay help-seeking, and compound errors; (4) families and home nurses often have different understandings of acceptable risk, responsibility, and goals when responding to home safety events. Conclusions: Our results identify opportunities for systemic interventions to support home nurses in responding to safety events for CMC. Improvements to training, equipment/supply reliability, communication, and real-time support may enhance home nurses’ ability to respond effectively to safety events, creating safer home care for CMC.