Hågensen Gunn, Nilsen Gudrun, Mehus Grete, Henriksen Nils
Department of Health and Care Sciences, UiT The Arctic University of Norway, Hammerfest, Norway.
Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Health Serv Res. 2018 Apr 25;18(1):302. doi: 10.1186/s12913-018-3101-2.
Every year, 14 % of patients in Norwegian hospitals experience adverse events, which often have health-damaging consequences. The government, hospital management and health personnel attempt to minimize such events. Limited research on the first-hand experience of the patients affected is available. The aim of this study is to present patients' perspectives of the occurrence of, disclosure of, and healthcare organizations' responses to adverse events. Findings are discussed within a social constructivist framework and with reference to principles of open disclosure policy.
This qualitative study with an explorative descriptive design included fifteen in-depth interviews with former patients recruited by the Health and Social Services ombudsmen in the two northernmost counties of Norway. Inclusion criteria were as follows: 1) experience of adverse events in connection with surgical, orthopedic or medical treatment in general hospitals; 2) men and women; 3) aged 20-70; and 4) a minimum of one year since the event occurred. Transcribed audio-recorded interviews were analyzed through qualitative content analysis.
The analysis revealed three main topics regarding patients' experiences of adverse events: 1) ignored concerns or signs of complications; 2) lack of responsibility and error correction; and 3) lack of support, loyalty and learning opportunities. Patients had to struggle to demonstrate the error that had occurred and to receive the necessary treatment and monitoring in the aftermath of the events.
Patient narratives reveal a lack of openness, care and responsibility in connection with adverse events. Conflicting power structures, attitudes and established procedures may inhibit prevention, learning and patient safety work in spite of major efforts and good intentions. Attitudes in day-to-day patient care and organizational procedures should be challenged to invite patients into open disclosure processes and include them in health and safety work to a greater extent. The study's small sample of self-selected participants limits the generalizability of the findings, and future studies should include a larger number of patients as well as professional perspectives.
挪威医院每年有14%的患者遭遇不良事件，这些事件往往会对健康造成损害。政府、医院管理层和医护人员都试图尽量减少此类事件的发生。然而，关于受影响患者的第一手经历的研究却很有限。本研究的目的是呈现患者对不良事件的发生、披露以及医疗保健机构对此类事件的应对措施的看法。研究结果将在社会建构主义框架内进行讨论，并参考公开披露政策的原则。
本定性研究采用探索性描述性设计，对挪威最北部两个郡的卫生和社会服务监察员招募的15名曾住院的患者进行了深度访谈。纳入标准如下：1）在综合医院接受外科、骨科或内科治疗时经历过不良事件；2）男女不限；3）年龄在20至70岁之间；4）事件发生至少一年。通过定性内容分析法对转录的录音访谈进行分析。
分析揭示了患者不良事件经历的三个主要主题：1）对并发症的担忧或迹象被忽视；2）缺乏责任感和纠错措施；3）缺乏支持、忠诚度和学习机会。事件发生后，患者不得不努力证明所发生的错误，并获得必要的治疗和监测。
患者的叙述揭示了在不良事件方面缺乏开放性、关怀和责任感。尽管付出了巨大努力且初衷良好，但相互冲突的权力结构、态度和既定程序可能会阻碍预防、学习和患者安全工作。应挑战日常患者护理中的态度和组织程序，以便让患者参与公开披露过程，并在更大程度上让他们参与健康和安全工作。本研究中自我选择的参与者样本较小，限制了研究结果的普遍性，未来的研究应纳入更多患者以及专业人士的观点。
