Nurses' responses to severity dependent errors: a study of the causal attributions made by nurses following an error

Attribution theory attempts to understand how people explain events and their own role in them, particularly events which are unusual or unpleasant. Based on previous studies on attributions, it was suggested that nurses would make more external attributions (i.e. blaming others or the environment) following an error with a serious outcome than one with a non-serious outcome. This would in turn suggest that they might be less likely to respond constructively and learn from serious errors. Sixty nurses were approached for this study. They were divided into two groups. One group (30 subjects) completed a questionnaire on the responses to a description of an error with a non-serious outcome and the second group (also 30 subjects) responded to questions to an identical error but with a serious outcome. The findings from this study indicated that nurses behaved in an atypical manner in response to making an error. Although both groups of nurses tended to make slightly more internal attributions for the error, indicating that they are likely to take responsibility for their error, those nurses in the serious outcome condition blamed themselves more for the error. This may be due to the strong professional ethos which exists amongst nurses that expects them to take responsibility for their actions. This would inevitably include any error that they may make in the course of giving care. The conclusion that can be drawn is that nurses might be quite receptive to making constructive changes in their practice following an error, provided this situation is managed properly.

Learning from errors in nursing practice

Little attention is paid to the issue of errors in nursing practice. Staff are reluctant to discuss or publicize them. However, as clinical audit and quality management become more important and established in the health service, there is now a greater need to investigate and monitor the incidence of errors. The purpose of this study was to examine the causes and consequences of errors as well as the potential for errors to initiate changes in practice. One hundred and twenty-nine nurses answered a 22-item questionnaire relating to an error they had made. Nurses reported that the most common causes of errors were lack of knowledge or information, work overload, stressful atmosphere and lack of support from senior staff. Nurses were found to have recourse to a number of coping strategies in the aftermath of the error. Accepting responsibility and planful problem-solving were found to lead to positive changes in practice, whereas distancing and self-controlling strategies were associated with defensive changes, particularly with a tendency not to divulge the error. The findings also showed that errors had the potential to effect learning. The study suggests the need for staff to be encouraged to accept responsibility for their error within the framework of support. Strategies should be developed so that errors can be managed in a more constructive manner.