Running head: NURSING QUALITY AND SAFETY WEEK EIGHT 1

Nursing Quality and Safety Write it Down Week Eight

Angelica Morales

Keiser University
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Nursing Quality and Safety Write it Down Week Eight

There are four steps to take in the immediate aftermath of an adverse event. Step one

solely requires caring for the patient. Step two consists of communicating with the patient. Step

three is reporting what happened to the appropriate parties. Last, step four consists of

documenting the event in the medical record. There has been some discussion over the effects

and aftermath of apologies when an adverse event occurs. However, the importance of an

apology is so crucial for the well-being of the patient or anyone in the patients’ family who was

hurt by the event. The important thing to remember is that an apology can do more harm than

good if it is not demonstrated in a way that shows remorse. Apologizing is so important because

it shows empathic characteristics towards the patient. It shows acknowledgment on the fallibility

and identifies action that prevents reoccurrence of the mistakes. It portrays an opportunity for the

patients to build a nurse-patient rapport being able to trust their caregivers and not abadon them.

Affective apologies have a correlation with reducing lawsuits. When a caregiver apologizes they

offer a transparent side to nursing, admitting to their fallacy. A proper and effective apology can

only be done so through great communication skills. It should demonstrate concern and

understanding. Aasron Lazare describes the four steps of an effect apology as,

“Acknowledgement, explanation, expression of remorse, shame and humility, and

reparation” ( IHI PS105, 2018).

First, acknowledgement consists of identifying the participants, details of what happened, and

validation that what happened was unacceptable or intolerable. Second, explanation talks about

the acceptance of responsibility for the event as making it very clear to the patient that that what

happened was not their fault. Third, expression of remorse, shame and humility has three parts.

They should be remorseful in that they demonstrate a deep feeling of regret. They should be feel
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shamed in that they didn’t live up to one’s own standards and expectations and they should be

humble and not arrogant. Lastly, reparation consists of going the extra mile. Giving the sense of

closure towards the patient to make amends.

In healthcare, sometimes the victims go beyond the patient and the families. Sometimes

the second victim can be the person who is at fault. Dr. Albert Wu mentions the term “the second

victim” involving the clinician or the caregiver who become emotionally involved. They become

so emotionally involved that they experience their own trauma impacting their lives negatively.

They experience feelings of isolation and shame. One way to help the clinician is to provide

system for which they are counseled to talk about their feelings. Giving them a platform that

encourages them to vent their feeling helps them return to their state of mind. Gossip should be

limited in the healthcare environment because this can create a hostile environment. Nursing

directors should implement a system that reprimands anyone who disrupts the healing and quite

environment of the facility. This ultimately affects the patient and can be a contributing factor to

medical errors as a form of distraction.

When accidents occur, a root cause analysis is commonly used to understand the errors

and failures that happened. RCA’s are team-oriented and effective. There are four question that

start an RCA. What happened, why did it happen, what is necessary in the prevention of it

reoccurring, and how will the changes made actually improve the safety of the system. Asking

the question what happened is the information gathering phase where the team describes what

happened completely and accurately. This can be done through an outline. An outline may be a

flowchart. Interviewing staff should collect additional information, observing patient flow,

conversing with others if they were there when accident occurred, and interviewing medical

staff. Determining what should’ve happened asks questions regarding hospital policy
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competencies. Hospital policies are read thoroughly questioning if good evidence based practice

was used. The department director may be interviewed about any barriers to safe practice.

Determining the causes is the heart of the RC, focusing on the plans to improve the strategies of

two types of contributing factors, direct causes, and contributory causes. Direct causes are like

symptoms of the bigger cause. They are easier to find are immediate reasons for an event. They

are like those of active errors. Contributory facts are indirect and are like latent errors. They

should be focused on as a direct cause wouldn’t occur without the contributory cause. A group of

four to six people should be included in the RCA team. They should be interprofessional

containing individuals at different levels that can represent their knowledge base of the issues

and processes involved in the accident. Members may include those of the caregiving team,

members of risk management or quality improvement departments, and patients or family

members involved in the incident.

The healthcare system is not perfect. It requires caregivers to be transparent and admit

their fallacies. They should be readily adept to apologizing in an effective manner. They should

be able to understand when a root cause analysis is needed, as well as the pieces of information

so it is effective and depicts the changes needed to improve healthcare.

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References

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