Study On Attitudes And Influencing Factors Of Doctors And Nurses Disclosing The Medical Adverse Events

Objective:This objective of this research is to understand the attitude and influencing factors of doctors and nurses to disclose medical adverse events.To further explore the impact of impeding factors on the attitude of doctors and nurses disclosing the medical adverse events and the influence of the promotion factors on the attitude of doctors and nurses disclosing the medical adverse events.Methods:(1)Qualitative research:Semi-structured interviews with doctors and nurses.Understanding the actual experiences and real world views of doctors and nurses in disclosing the medical adverse events.(2)Investigative research:This research,combined with the information obtained from qualitative research and literature review,compiles the questionnaire under the guidance of theoretical framework.A total of 610 doctors and nurses of 2 hospitals in wuhan city were surveyed.Using the SPSS21.0 to analyze the data collected to draw the corresponding conclusions.Results:(1)In the qualitative study,Four themes were extracted:the experience of disclosure;the views and opinions of disclosure;the obstacles of disclosure;needs and help.(2)The Cronbach's alpha coefficient and the retest coefficient of the questionnaire were 0.758 and0.952,respectively.The content of the questionnaire was better.The questionnaire has good reliability and validity and can be used to investigate the attitudes and influencing factors of doctors and nurses disclosing the medical adverse events.(3)In the aspect of experience,30(71.0%)doctors and 192(50.4%)nurses indicated that they had disclosing the patients of medical adverse events.The vast majority of nurses(74.3%)and doctors(86.3%)have no training experience.However,30.9% of doctors and 86.9% of nurses all indicated that they would be willing to attend training in the future.In the aspect of attitude,378(67%)doctors and nurses supported the disclosure of level I incident;348(61.7%)doctors and nurses supported the disclosure of level?incident;327(58%)doctors and nurses supported the disclosure of level ? incident;219(38.8%)doctors and nurses supported the disclosure of level ? incident.No matter what kind of medical adverse events,most of the doctors and nurses choose partial disclosure(63.7%,68.1%,57.6%,42%).In the aspect of influencing factors,the research shows that obstructive factors are as follows: "worried about the adverse impact on hospitals and departments"(3.95±0.85);"worried about taking legal and compensation(3.94 ± 0.92);"worried about patient's irrational behavior"(3.85±0.92);"worried about the negative emotions of the patient"(3.85 ± 0.92);"worried about being punished by the hospital"(3.84 ± 0.96).Further multivariate linear regression analysis found that "the fear of assuming the law and the responsibility of compensation" is the most important impediment to doctors and nurses.The top five promoters of disclosure were the following: the desire to respect the patients' right to know(4.51±0.52),the high degree of serious medical adverse events(4.47±0.54),the familiarity with patients(4.46±0.56),reasonably communicate(4.43±0.56);relieve my guilt(4.42 ± 0.56).Multivariate linear regression analysis found that"reasonably communicate" and "relieving guilt" had a higher influence on disclosing.Conclusions:(1)Some doctors and nurses have been disclosed and the results are better.The vast majority of doctors and nurses did not receive the education and training,but all said they would be willing to participate in education and training.(2)The doctors and nurses support to disclose medical adverse events but still have concerns.The attitude of disclosing medical adverse events increases as the severity of the harm caused by medical adverse events increases.The doctors and nurses do not consider it necessary to disclose the near miss.(3)Most of the doctors and nurses choose to disclose partially,it is difficult to disclose patients and their families all the truth without reservation.(4)Obstacles to disclose come mainly from the "fear and anxiety" of doctors and nurses."fear and anxiety"is a series of potential negative results.The main obstacle is the fear of assuming legal responsibility and compensation.(5)The disclosure of the promotion of the main sources of"responsibility to the patient," The doctors and nurses want to respect the patient's right toknow and hope that patients who are harmed can be effectively treat.The main driving factor is the rational communication and the alleviation of the guilt of doctors and nurses.