Toward a Theory of Self‐Reconciliation Following Mistakes in Nursing Practice

Abstract

This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested.

Nurses' experiences with errors in nursing

“…For example, researchers typically have not differentiated between formal and informal error reporting (Covell & Ritchie, 2009;Crigger & Meek, 2007;Elder, Brungs, Nagy, Kudel, & Render, 2008) whereas our findings suggest that these are two different types of experiences with differing implications. Some studies have explored nurses' attitudes and immediate responses to errors but have not explored how nurses cope with having made an error over time (Sirriyeh, Lawton, Gardner, & Armitage, 2010).…”

Ethical Standards for Disclosing a Medical Error

“…The barriers that impede error disclosure are multiple. For example, providers commonly fear litigation and being reported to the public registry [11][12][13]. They often perceive a lack of institutional support and do not know how to communicate to patients about an error [11,14].…”

“…Personal attitudes, uncertainties about the nature of the event, perceived helplessness, and additional anxieties are further factors that commonly contribute to nondisclosure [15]. Furthermore, providers often assess the likelihood of an error being discovered, the number of previous mistakes, patient characteristics, the culture of their work environment, the patient's state of consciousness, and the availability of family members [13]. Given the complexity of these important considerations, it is not surprising that despite legal and ethical obligations, a majority of medical errors remain undisclosed [16].…”

Nurses are not bystanders: A response to Paley

“…This would reduce the inconsistency and therefore the discomfort. However, if the behaviour, the non-compassionate care, has already taken place and cannot be reversed, it is more likely that rationalisations (Crigger and Meek, 2007), justifications or excuses will be formulated to reduce the dissonance. Such arguments will be affected by the hospital culture.…”

“…Specific to nursing, Taylor and Bentley (2005) coined the term professional dissonance to understand conflict between practice and care values in mental health nursing. Crigger and Meek (2007) studied self-reconciliation after nursing mistakes with reference to cognitive dissonance. Fontenot et al (2012) investigated how nursing educators experience dissonance, while De Vries (2008) applied the theory to the practice of the 'slow code' in cardiac care.…”