Cent Eur J Nurs Midw 2023, 14(2):887-895 | DOI: 10.15452/cejnm.2023.14.0004

Surgical nurse experience with adverse events – a descriptive qualitative study

Dominika Kohanová, Soňa Baránková, Radka Kurucová, Katarína Žiaková
Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia

Aim:  To explore the experience of surgical nurses with adverse events. Design: A descriptive qualitative study. Methods: Data were collected between August 2021 and February 2022 using semi-structured interviews. Participants were nurses (n = 10) working in surgical care units in a teaching hospital in the Slovak Republic. The interviews were recorded on an audio recorder and transcribed verbatim. Data were analyzed using thematic analysis. Results: Two main themes were identified: Adverse events in the surgical workplace and Preventive strategies aimed at reducing adverse events. Several subthemes specified themes and reflected the nurse’s experience with adverse events in surgical settings. Conclusion: Surgical workplaces are at risk of adverse events due to the number of surgical procedures. Given that most adverse events are preventable and systemic factors are responsible for their occurrence, we recommend implementing risk management, including active identification of patients at risk, teamwork support, management of missing resources, adjustment of the environment, and creation of a positive patient safety culture.

Keywords: acute care, adverse events, nurses, qualitative research, surgical units

Received: July 12, 2022; Revised: February 7, 2023; Accepted: February 7, 2023; Prepublished online: March 4, 2023; Published: June 5, 2023  Show citation

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Kohanová D, Baránková S, Kurucová R, Žiaková K. Surgical nurse experience with adverse events – a descriptive qualitative study. Central European Journal of Nursing and Midwifery. 2023;14(2):887-895. doi: 10.15452/cejnm.2023.14.0004.
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    References

    1. Batista, J., Cruz, E., Alpendre, F. T., Rocha, D., Brandão, M. B., & Maziero, E. (2019). [Prevalência e evitabilidade de eventos adversos cirúrgicos em hospital de ensino do Brasil] Prevalence and avoidability of surgical adverse events in a teaching hospital in Brazil. Revista Latino-Americana de Enfermagem, 27, e2939. https://doi.org/10.1590/1518-8345.2939.3171 Go to original source... Go to PubMed...
    2. Bergen, G., Stevens, M. R., Kakara, R., & Burns, E. R. (2021). Understanding modifiable and unmodifiable older adult fall risk factors to create effective prevention strategies. American Journal of Lifestyle Medicine, 15(6), 580-589. https://doi.org/10.1177/1559827619880529 Go to original source... Go to PubMed...
    3. Braun, V., & Clarke, V. (2022). Thematic analysis: a practical guide. Sage. Go to original source...
    4. Carlson, J. A. (2010). Avoiding traps in member checking. The Qualitative Report, 15, 1102-1113.
    5. Chang, H. E., Jang, H., & Bak, Y. I. (2022). Clinical nurses' recovery experiences after adverse events in South Korea: a qualitative study. Collegian, 29(4), 456-464. https://doi.org/10.1016/j.colegn.2021.10.012 Go to original source...
    6. de Vries, E. N., Ramrattan, M. A., Smorenburg, S. M., Gouma, D. J., & Boermeester, M. A. (2008). The incidence and nature of in-hospital adverse events: a systematic review. BMJ Quality & Safety, 17(3), 216-223. https://doi.org/10.1136/qshc.2007.023622 Go to original source... Go to PubMed...
    7. Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses' knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC Nursing, 18, 20. https://doi.org/10.1186/s12912-019-0346-y Go to original source... Go to PubMed...
    8. Henriksen, K., Dayton, E., Keyes, M. A., Carayon, P., & Hughes, R. (2008). Understanding adverse events: a human factors framework. In: Hughes, R. G. (Ed.), Patient safety and quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK2666/
    9. Kakemam, E., Hajizadeh, A., Azarmi, M., Zahedi, H., Gholizadeh, M., & Roh, Y. S. (2021). Nurses' perception of teamwork and its relationship with the occurrence and reporting of adverse events: A questionnaire survey in teaching hospitals. Journal of Nursing Management, 29(5), 1189-1198. https://doi.org/10.1111/jonm.13257 Go to original source... Go to PubMed...
    10. Kalánková, D., Kirwan, M., Bartoníčková, D., Kurucová, R., Žiaková, K., & Gurková, E. (2021). How adverse event reporting in the Slovak Republic is influenced by nurse characteristics and working arrangements: a cross-sectional study. Kontakt, 23(2), 97-103. https://doi.org/10.32725/kont.2020.033 Go to original source...
    11. Kalánková, D., Kirwan, M., Bartoníčková, D., Cubelo, F., Žiaková, K., & Kurucová, R. (2020). Missed, rationed or unfinished nursing care: A scoping review of patient outcomes. Journal of Nursing Management, 28(8), 1783-1797. https://doi.org/10.1111/jonm.12978 Go to original source... Go to PubMed...
    12. Kang, J.-H., Kim, C.-W., & Lee, S.-Y. (2014). Nurse-perceived patient adverse events and nursing practice environment. Journal of Preventive Medicine and Public Health, 47(5), 273-280. https://doi.org/10.3961/jpmph.14.019 Go to original source... Go to PubMed...
    13. Labat, F., & Sharma, A. (2016). Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo. BMJ Open, 6(4), e009379. https://doi.org/10.1136/bmjopen-2015-009379 Go to original source... Go to PubMed...
    14. Lipsitz L. A. (2012). Understanding health care as a complex system: the foundation for unintended consequences. The Journal of American Medical Association, 308(3), 243-244. https://doi.org/10.1001/jama.2012.7551 Go to original source... Go to PubMed...
    15. Liukka, M., Steven, A., Moreno, M., Sara-Aho, A. M., Khakurel, J., Pearson, P., Turunen, H., & Tella, S. (2020). Action after adverse events in healthcare: an integrative literature review. International Journal of Environmental Research and Public Health, 17(13), 4717. https://doi.org/10.3390/ijerph17134717 Go to original source... Go to PubMed...
    16. Mitchell, D., Raymond, M., Jellett, J., Webb-St Mart, M., Boyd, L., Botti, M., Steen, K., Hutchinson, A., Redley, B., & Haines, T. (2018). Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services. International Journal of Nursing Studies, 86, 52-59. https://doi.org/10.1016/j.ijnurstu.2018.06.002 Go to original source... Go to PubMed...
    17. Neuberg, M., Meštrović, T., Ribić, R., Šubarić, M., Canjuga, I., & Kozina, G. (2019). Contrasting vantage points between caregivers and residents on the perception of elder abuse and neglect during long-term care. Psychiatria Danubina, 31(Supplementum 3), 345-353. Go to PubMed...
    18. Nilsson, L., Risberg, M. B., Montgomery, A., Sjödahl, R., Schildmeijer, K., & Rutberg, H. (2016). Preventable adverse events in surgical care in Sweden: a nationwide review of patient notes. Medicine, 95(11), e3047. https://doi.org/10.1097/MD.0000000000003047 Go to original source... Go to PubMed...
    19. Patiraki, E., Karlou, C., Efstathiou, G., Tsangari, H., Merkouris, A., Jarošová, D., Leino-Kilpi, H., Suhonen, R., Balogh, Z., Palese, A., Tomietto, M., & Papastavrou, E. (2014). The relationship between surgical patients and nurses' characteristics with their perceptions of caring behaviors: a European survey. Clinical Nursing Research, 23(2), 132-152. https://doi.org/10.1177/1054773812468447 Go to original source... Go to PubMed...
    20. Pazokian, M., & Borhani, F. (2017). Nurses' perspectives on factors affecting patient safety: a qualitative study. Evidence Based Care Journal, 7(3), 76-81. https://doi.org/10.22038/EBCJ.2017.24174.1520 Go to original source...
    21. Pickering, C., Nurenberg, K., & Schiamberg, L. (2017). Recognizing and responding to the "toxic" work environment: worker safety, patient safety, and abuse / neglect in nursing homes. Qualitative Health Research, 27(12), 1870-1881. https://doi.org/10.1177/1049732317723889 Go to original source... Go to PubMed...
    22. Recio-Saucedo, A., Dall'Ora, C., Maruotti, A., Ball, J., Briggs, J., Meredith, P., Redfern, O. C., Kovacs, C., Prytherch, D., Smith, G. B., & Griffiths, P. (2018). What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing, 27(11-12), 2248-2259. https://doi.org/10.1111/jocn.14058 Go to original source... Go to PubMed...
    23. Ridelberg, M., Roback, K., & Nilsen, P. (2014). Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions. BMC Nursing, 13, 23. https://doi.org/10.1186/1472-6955-13-23 Go to original source... Go to PubMed...
    24. Schwendimann, R., Blatter, C., Dhaini, S., Simon, M., & Ausserhofer, D. (2018). The occurrence, types, consequences and preventability of in-hospital adverse events - a scoping review. BMC Health Services Research, 18(1), 521. https://doi.org/10.1186/s12913-018-3335-z Go to original source... Go to PubMed...
    25. Serou, N., Slight, S. P., Husband, A. K., Forrest, S. P., & Slight, R. D. (2021). Surgical incidents and their impact on operating theatre staff: qualitative study. BJS Open, 5(2), zraa007. https://doi.org/10.1093/bjsopen/zraa007 Go to original source... Go to PubMed...
    26. Shin, S., Park, J. H., & Bae, S. H. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook, 66(3), 273-282. https://doi.org/10.1016/j.outlook.2017.12.002 Go to original source... Go to PubMed...
    27. Stayt, L. C., Merriman, C., Bench, S., M., Price, A., Vollam, S., Walthall, H., Credland, N., Gerber, K., & Calovski, V. (2022). 'Doing the best we can': registered nurses' experiences and perceptions of patient safety in intensive care during COVID-19. Journal of Advanced Nursing, 78(10), 3371-3384. https://doi.org/10.1111/jan.15419 Go to original source... Go to PubMed...
    28. World Health Organization. (2019). Patient safety. WHO. https://www.who.int/news-room/fact-sheets/detail/patient-safety
    29. Zaheer, S., Ginsburg, L., Wong, H. J., Thomson, K., Bain, L., & Wulffhart, Z. (2021). Acute care nurses' perceptions of leadership, teamwork, turnover intention and patient safety - a mixed methods study. BMC Nursing, 20(1), 134. https://doi.org/10.1186/s12912-021-00652-w Go to original source... Go to PubMed...
    30. Zarea, K., Mohammadi, A., Beiranvard, S., Hassani, F., & Baraz, S. (2018). Iranian nurses' medication errors: a survey of the types, causes, and the related factors. International Journal of Africa Nursing Sciences, 8, 112-116. https://doi.org/10.1016/j.ijans.2018.05.001 Go to original source...
    31. Zeeshan, M. F., Dembe, A. E., Seiber, E. E., & Lu, B. (2014). Incidence of adverse events in an integrated US healthcare system: a retrospective observational study of 82,784 surgical hospitalizations. Patient Safety in Surgery, 8, 23. https://doi.org/10.1186/1754-9493-8-23 Go to original source... Go to PubMed...
    32. Zegers, M., de Bruijne, M. C., de Keizer, B., Merten, H., Groenewegen, P. P., van der Wal, G., & Wagner, C. (2011). The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Safety in Surgery, 5, 13. https://doi.org/10.1186/1754-9493-5-13 Go to original source... Go to PubMed...

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