An examination of organizational and nursing factors impacting patient risk detection

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Patient harm continues to occur in health care settings despite the expenditure of resources to reduce its incidence. As the health care providers with the most direct patient contact, nurses are most likely to detect subtle changes presaging patient harm if they are in an environment that supports them in that role. Much has been published regarding how organizations impact patient safety yet little attention has been given to how individual nurses detect risks of patient harm. Therefore the Patient Risk Detection theoretical framework integrating attributes from both an organizational theory and a cognitive psychology theory was developed and used examine the relationship between leadership behaviors intended to convey a goal of patient safety and the detection of patient risk and explore other factors impacting this performance. Results indicated that the intervention was not strong enough to activate a goal of patient safety. Other results revealed higher perceptions about the quality of the work environment enhanced the ability to correctly ignore a clinically irrelevant alarm. Nurses appeared to prioritize correctly ignoring an irrelevant alarm over correctly responding to an alarm indicative of a potential change in the patient's clinical status. Further research is necessary to extend knowledge of nurse detection of patient risk. Additional empirical testing of this framework is needed and will be valuable in validating its use in the nursing domain.