Nurses Perception on Voluntary Error and Near Miss Reporting in Hospital

The present paper is a research proposal related to the field of nursing. This study focuses on issues of efficiency of nursing performance and patient safety. The ultimate purpose of the study is to evaluate the role of nurses’ perceptions on a voluntary error and near-miss reporting. Proper and timely reporting is significant since it is regarded as a major tool in the prevention of further errors and augments the level of patient safety. The proposed study is intended to be conducted in hospital X. Primary research will be supported by secondary sources. The literature review will constitute secondary research, and a cross-sectional study serves as the primary research. Qualitative research and use of a questionnaire will be utilized in the proposed study. The expected amount of responses is 220. The final outcomes of the study will be a report and brochures. The report will be used for academic purposes, whereas brochures will be distributed in other local hospitals for use in practice.

Abbreviations

WHO – World Health Organization

CIRS – critical incident reporting systems

MMMs – morbidity-mortality meetings

Introduction

Background of the Study

The present study focuses within the scope of nursing and its efficiency. The ultimate focus of the given research is to study the perceptions of voluntary error and near miss reporting of nursing personnel in their daily practice. These aspects will be explored from the perspective of influence on healthcare outcomes and nursing efficiency as well as from the view of impact on nursing personnel. Such an approach will provide a holistic picture of the case and is expected to result in significant research results. The problem of recurring errors in nursing practice is a serious threat to patients recovery, overall health condition, and even life (Jones, 2013). Malhotra, Goyal, Walia, and Aslam (2012) underline that errors made by healthcare personnel often provoke various disasters and must be prevented. Such statistics confirm that patient safety, the ultimate priority of the whole healthcare system, is strongly compromised. It is possible to prevent such an alarming rate of the errors made by healthcare staff, and a most urgent study is required in the field of nursing to find a solution for minimizing these errors. Hence, it is crucial to situate the currently discussed issue, conduct preliminary in-depth study of the credible sources and empirical evidence so that the primary research is justified and relevant, and afterwards conduct a qualitative investigation with consequent analysis and inferences. The gap in the given area of knowledge concerns the potential for prevention of the nursing errors, and one of the approaches to provide it is voluntary error and near miss reporting. Study of nurses errors and their perception is crucial since errors in nursing practice are concluded to be under-reported (Faraq, Blegen, Gedney-Lose, Lose & Perkhounkova, 2017), but they predetermine further efficiency of nursing performance and actual safety of patients (Mayo & Duncan, 2004). Hence, the present study will contribute to the identified field by means of empirical research, the results of which can be used either for further research or for actual improvement of error reporting and error prevention in nursing.

Problem Statement

The main problem that is addressed in the present study is the hazards of insufficient voluntary error and near miss reporting in nursing that subsequently provoke incremental rates of nursing errors and low quality performance. The errors can be prevented only when the whole picture of daily performance is presented in nursing reports.

General Purpose of the Study

The ultimate purpose of the study is to contribute to development of preventive measures aimed at minimizing nursing errors.

Specific Objectives of the Study

Specific objectives of the present research are such as:

• to identify the major reasons for under-reported errors;
• to identify the factors impacting timeliness of voluntary error and near-miss reporting;
• to address the incidents of nurses errors leading to serious repercussions;
• to demonstrate how the identification of potential risks improves nursing performance and contributes to patient safety;
• to demonstrate how reporting errors can be a crucial step in professional growth but not vice versa.

Research Questions

1. What are the main reasons of under-reporting of voluntary errors and near miss cases in nurses?

2. Why do nurses report errors in an untimely or incomplete manner?

3. How do nurse errors endanger patients’ health and life?

4. How can identifying potential risks enhance nursing performance and contribute to patient safety?

5. How can the reporting of errors contribute to professional growth?

6. What strategies and methods should be introduced in modern healthcare establishments in order to motivate and encourage the personnel to report their voluntary errors and near miss cases timely and entirely?

7. What are the benefits of timely reporting of potential risks?

Significance of the Study

The present research is crucial for the field of effective nursing practice as far as it is expected to result in precise, vivid, and credible evidence that can improve the rate of timely and complete error reporting and, consequently, the overall efficiency of nursing personnel. The study will employ both primary and secondary types of research so as to conduct holistic and justified insight into the issue in question. Secondary research will be based on reliable, up-to-date and trustworthy studies from authoritative sources. Primary research will rely on the findings of secondary sources and will employ qualitative approach in order to acquire necessary data. As a result, the study will collect the most significant works on the topic of investigation so as to present the most essential findings of the recent research, and at the same time will present authentic evidence collected from eleven units and aimed at direct contribution to nursing efficiency and patient safety issues.

Definition of Terms

The following terms require proper definition: 1) Voluntary error reporting implies the opportunity to tell the complete story without fear of retribution (Cohen, 2000, p. 729). The nurse provides information about the error so that a reader can understand both its causes and attitude of the nurse to this error. This is a type of reporting system contrary to the mandatory one. 2) Near miss reporting constitutes for the potential damage. According to the report Near Miss Reporting Systems, A Near Miss is an unplanned event that did not result in injury, illness, or damage but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality, or damage (National Safety Council, 2013). In the context of nursing performance, reporting of near miss incidents encompasses each action or the absence of necessary action that could harm the patient(s) either directly or indirectly. The crucial attribute of the given term is that the event was not planned (WSH Council, 2016).

Literature Review

Patient safety is a direct responsibility of each healthcare expert (Elliott & Liu, 2010). Smith et al. (2014) conducted a significant study aimed at studying the attitudes of physicians to voluntary error and near miss reporting. There were 274 respondents to the offered survey (Smith et al., 2014). 93.8% of physicians agreed that errors occurred in their practice, and 97% confirmed that it was their direct responsibility to report about such cases (Smith et al., 2014). The major reasons for not reporting errors included fear of getting colleagues in trouble, the potentially negative effect on departmental reputation, liability, and overall embarrassment (Smith et al., 2014). Furthermore, according to Smith et al. (2014), the leading national and global health organizations such as WHO and International Atomic Energy Agency emphasize the ultimate importance of a reporting system as an integral part of an overall safety practice in healthcare sector. The underlying reason of its significance is that learning from errors and near miss cases is an essential step for each nurse in the development of mechanisms and strategies aimed at prevention of future occurrences of similar events. To be more precise, near miss cases serve as a prologue to the actual damage. The scholars present the following statistics of the issue in question: despite 84.3% of physicians believing that reporting medical errors improves quality, only 16.9% admitted reporting a minor error, and 3.8% acknowledged reporting a major error (Smith et al., 2014, p. 350). This evidence illustrates that healthcare personnel is aware of the significance of proper reporting only theoretically, as opposed to the real threat of revealing their own mistakes in professional activity. It becomes an especially serious problem with potential repercussions when a major error occurs and a nurse avoids its reporting since this is a crucial hazard to patient’s safety. Moreover, such incidents damage the rate of proficiency of the nurse in terms of errors without analysis tend to repeat with the course of time as well as reputation of the healthcare organization.

Hashemi, Nasrabadi and Asghari (2012) conducted a qualitative study that involved 115 nurses and employed a semi-structured group discussion as a major tool of data collection. Hashemi, Nasrabadi and Asghari (2012) confirm the negative tendency that is observed in the sphere of error reporting. Nursing errors provoke thousands of deaths, impose considerable harm on patients’ health conditions, and, consequently, cause an incremental rate of treatment expenses annually (Hashemi, Nasrabadi & Asghari, 2012). The scholars also present the evidence of the research conducted at the University of Pennsylvania that reveals the following: 30% of nursing personnel committed a minimum of one error within the 28 days of the study (Hashemi, Nasrabadi & Asghari, 2012). When analyzed on a wider scale, nursing errors are considered to be a sign of vulnerability of the whole system (Hashemi, Nasrabadi & Asghari, 2012). As discussed above, errors lead to increased endangered health condition of patients, failure of experts proficiency rate and reputation of the healthcare establishment put at stake. The researchers claim that different types of errors can be shared and tracked by healthcare providers and ways of reducing and preventing the incidences and reverse events can be taught, as well via reporting (Hashemi, Nasrabadi & Asghari, 2012, p. 1). Medication errors are the ones that occur most frequently and, subsequently, harm patients the most (World Health Organization, 2016). Baril, Gascon, St-Pierre and Lagac? (2014) also consider this error type to be a leading one nowadays.

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Milch et al. (2006) studied a standardized web-based reporting system in 26 acute care non-federal hospitals in the United States within the period of three month during which this program was implemented and used actively. There were 92,547 reports that covered 2,547,154 patient-days (Milch et al., 2006). The participants of this study were nurses, physicians, and administration. Milch et al. (2006) explain the core direction of use of the acquired data from error reports: the data should be structured, evaluated in terms of frequency of such incidents, their causes, actual effect on the patients and potential ones. In such a way, further performance of nurses can be modified, adjusted, improved. When personnel is honest and reports all the errors and near miss incidents, the healthcare organization is confident that the personnel are responsible and proficient. Furthermore, modern technological advancement provides the nurses with diversity if opportunities for reporting and consequent analysis of own errors and errors of colleagues.

Contemporary experts in the field of concern continue the perspective of error reporting and analysis. Faraq, Blegen, Gedney-Lose, Lose, and Perkhounkova (2017) employed a cross-sectional descriptive design and conducted a study that involved 71 emergency room nurses. The researchers used a questionnaire with a convenience sample of nursing personnel. The data acquired in the given study were analyzed by means of descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. The scholars posit that reporting can be encouraged and then modified properly by a constructive leadership style actualized by the managers (Faraq, Blegen, Gedney-Lose, Lose & Perkhounkova, 2017). The most important aspects expected in the reports are timeliness and honesty about the causes. Otherwise, value of the data provided becomes considerably lower.

Morrison (2014) expands the discussion of the significance of error reporting and posits that it contributes to the establishment and development of the culture aimed at safety and efficiency in the healthcare organization. This culture seeks to identify and control hazards, which will reduce risks and the potential for harm (Morrison, 2014). In such a way, the requirement of reporting both voluntary errors and near miss incidents outgrows the status of duty and becomes a personal responsibility, individual contribution, and action performed in correspondence with the code of the expert. It is also crucial to deal with the information acquired via reports from nurses properly and effectively. Morrison (2014) provides several examples: Fluor ranks the reported near miss incidents by their level of severity, and based on the rank the correspondent response is provided, namely, holistic investigation can be initiated in case the potential damage of a near miss is injury or death of a patient, whereas if the risk is lighter, the whole team is informed about it along with recommendations and adjustments aimed at prevention similar cases; PIKA shares the results and proposed solutions of further risk prevention with personnel by means of diverse platforms, and the most threatening near miss cases are discussed by the CEO at company meetings (Morrison, 2014). Provided the healthcare organization demonstrates such a holistic approach to dealing with these cases, engagement of employees also increases and acquires excellent quality. Forte, Pires, Padilha, and Martins (2017) also support the necessity of establishment of safety culture.

Manno, Hogan, Heberlein, Nyakiti, and Mee (2006) present a profound study of the issue of patient safety in terms of potential medication errors. A survey that consisted of 40 questions on safety issues was launched in September 2005, and 4,826 nurses residing in the US and Canada participated in it (Manno, Hogan, Heberlein, Nyakiti, & Mee, 2006). The respondents not only provided data on 40 survey questions, but also supplied their contribution to the given study with additional information written by hand about safety in the healthcare organization they belonged to (Manno, Hogan, Heberlein, Nyakiti, & Mee, 2006). Both a significant scale of research and such an in-depth approach to responses resulted in maximally detailed and objective picture on the issue in question. The given study featured diverse dimensions of nursing performance and safety. This allowed the scholars to identify crucial aspects of error reporting, attitudes and perceptions to this practice, and its potential for future use. Manno, Hogan, Heberlein, Nyakiti, and Mee (2006) conclude that culture that targets safety of performance is crucial for proficient care delivery, and highlight that the health care culture is shifting from a punitive or blaming approach to error reporting to an objective, constructive, and educational approach (p. 63). In such a way, it is evident that the percentage of personnel’s engagement in honest, timely, and holistic reporting of voluntary error and near miss incidents depends on the employer and organization’s approach considerably.

Elden and Ismail (2016) also focus on the issue of medication error as one of the major hazards for safety care delivery in contemporary healthcare system. Hence, a pre-test, post-test study was developed involving all inpatients at a hospital with 177 beds (Elden & Ismail, 2016). Each medication procedure was monitored by a clinical pharmacist (Elden & Ismail, 2016). Along with this, files of all the patients were studied and analyzed so as to collect all details. Furthermore, intervening measures in the form of training programs for nursing personnel were also conducted in terms of the given study (Elden & Ismail, 2016). The researchers conclude that a systematic approach to care delivery is urgently needed in modern hospitals in order to reduce organizational susceptibility to errors (Elden & Ismail, 2016). The scholars posit that this can be actualized via provision of necessary resources aimed to monitor, analyze and implement constructive interventions (Elden & Ismail, 2016). Hence, the stance that initial steps in the process of enhancement of nurses’ engagement in proper reporting are expected from the healthcare facility are confirmed in this study as well as in the previous ones.

Salviz, Edipoglu, Sungur, Altun, Buget, and Seyhan (2016) conducted a study on the topic of critical incident reporting systems (hereinafter, CIRS) and morbidity mortality meetings (hereinafter, MMMs). The survey was completed by anesthetists from 81 out of 114 teaching hospitals in Turkey. The results revealed that 96.3% of participants identified CI reporting as a necessity in modern hospitals, whereas only 37% of the healthcare establishments from the list were reported to have CIRS (Salviz et al., 2016). It is evident that even in the current course of time the problem of organizational readiness and sufficient supply remains topical. To be more precise, the initiative belongs to the facility, and only after proper engagement of the organization in motivation of employees and provision with necessities it is relevant to shift the focus to nurses engagement. The responsibility of the employees starts with the accountability of the employer.

Athanasakis (2012) presents a literature review on the issue of medication errors and prevention of such incidents by nurses. The sources were collected from Medline, Science Direct and Cochrane Library within the period of time between January 2000 and August 2011 (Athanasakis, 2012). The researchers underline that the ultimate role in this process belongs to manager and educator nurses with the exception of clinical nurses (Athanasakis, 2012). Furthermore, a set of constructive changes in the system of medication management is required to decrease medication errors (Athanasakis, 2012). Therefore, it is crucial to highlight that nurses’ negligence and lack of competence are not the only or even leading causes of medication errors, as it becomes obvious from the present literature review. Oyebode (2013) states that new technologies are a starting point for the changes in the system. Dolansky, Druschel, Helba, and Courtney (2013) underline that prevention of medication errors should start from student practice and continue in terms of professional performance.

One more study related to the scope of medication error and its reporting among nurses was conducted by Hayes, Jackson, Davidson, and Power (2015). This is a systematic critical review that relies on 19 credible articles found in such databases as Medline, Scopus, PubMed and CINAHL. The researchers underline that medication is a challenging practice that requires multiple clinical judgments, professional vigilance and critical thinking (Hayes, Jackson, Davidson, & Power, 2015, p. 13). Furthermore, the scholars highlight that the environment is rather dynamic and often even chaotic, implying that all these factors have major influence on potential error (Hayes, Jackson, Davidson, & Power, 2015). Multitasking becomes a usual routine for many nurses, and as a result, quality suffers from it. The scholars claim that proper comprehension of the responsibility to manage such challenging human factors as interruptions of diverse nature that can potentially influence safety of care delivery is concluded to be an integral part of the whole process in question (Hayes, Jackson, Davidson, & Power, 2015). Finally, the authors of literature review posit that the key to efficient performance of nurses and prevention of medication errors in the future is adapting and utilizing interruption and distraction reduction strategies, along with existing and emerging teaching methods to enhance the nurse’s ability to navigate their way through situations where interruptions and distractions are inevitable, and multitasking unavoidable (Hayes, Jackson, Davidson, & Power, 2015, p. 13).

Hence, it is evident that errors are often a direct result of deficit overall healthcare system, its efficiency and potential. Agbor (2016) agrees, stating that it is a system as a whole that needs to be improved first. Still, nurses are often at the core of implementing and sustaining system improvements (Armstrong, 2016, p. 40). Nurses are often reluctant to report about voluntary errors or near miss cases based on other, more personalized reasons. Therefore, it is relevant to discuss these reasons in more detail. For example, Castel, Ginsburg, Zaheer, and Tamim (2015) study the fear of nursing and physicians related to reporting. To be more precise, healthcare personnel often fear repercussions of the reported errors, and the researchers delve into the issue so as to conduct an in-depth insight in implicit causes of under-reporting. According to Castel, Ginsburg, Zaheer, and Tamim (2015), for a positive patient safety climate to exist, theoretical as well as empirical investigations argue that strong, credible and visible support for patient safety initiatives by organization leaders is central to a positive patient safety climate (p. 2). Therefore, preventive measures are the core tool for ensuring patients’ safety and efficiency of employees’ performance. Castel, Ginsburg, Zaheer and Tamim (2015) conducted a study of the fear of repercussions having employed a Modified Stanford Instrument-2006 (MSI-06). Data was collected by Ginsburg and colleagues in three Canadian provinces, namely, in Manitoba, Ontario and Nova Scotia, in 2005 and 2006. Ten multi-site health care organizations were involved as participants in the given study (Castel, Ginsburg, Zaheer, & Tamim, 2015). Concerning the number of nurses and physicians who partook in the given survey, the scholars provide the following information: 6,243 of 22,623 surveys were returned for a response rate of 28%. Of these responders, 2,320 were nurses (30.4% response rate) and 386 were physicians (23.6% response rate) (Castel, Ginsburg, Zaheer, & Tamim, 2015). Hence, the amount of participants was sufficient for justified and credible research results of the study. The prevailing number (95%) of nursing personnel was female (Castel, Ginsburg, Zaheer, & Tamim, 2015). Based on the acquired outcomes and their thorough analysis, the following inferences were made: the demographics impacts the fear of repercussions of reporting less in comparison with the location; when clinicians are afraid to report patient safety problems, a key pathway to reducing morbidity and mortality from medical error fails (Castel, Ginsburg, Zaheer, & Tamim, 2015, p. 8); the expected blame increases fear and is destructive in the formation of personnel who are not afraid of filing honest reports; further empirical studies of the issue in question as well as tailored safety interventions are recommended (Castel, Ginsburg, Zaheer, & Tamim, 2015). These are important outcomes for the currently explored area since they reveal the implicit factors that should be addressed and adjusted in order to improve the level of patient safety in terms of care delivery.

The next crucial study that contributes to overall understanding of the given topic was conducted by Banakhar, Tambosi, Asiri, Banjar, and Essa in 2017. The researchers focused their investigation on the main barriers of reporting errors among nursing personnel. The scholars employed a descriptive cross-sectional study among nurses in Saudi Arabia (Banakhar, Tambosi, Asiri, Banjar, & Essa, 2017). The major tool was a questionnaire, and the study used responses of 154 nurses (Banakhar, Tambosi, Asiri, Banjar, & Essa, 2017). The data was managed by means of descriptive statistical analysis, and the results reveal the following: the major barriers to proper, timely and complete reporting of the errors included lack of time and excessively complicated and exhausting work, whereas fear of being blamed afterward was not claimed to be a barrier as far as the hospitals adhere to constructive non-blaming culture (Banakhar, Tambosi, Asiri, Banjar, & Essa, 2017). Apparently, the barriers can be overcome easily via better involvement of management. To be more precise, the hospitals should increase the number of employees and distribute responsibilities and duties in such a way that nurses are not overloaded with non-nursing tasks (Banakhar, Tambosi, Asiri, Banjar, & Essa, 2017).

Thus, the collected data reveals the necessity to improve many aspects of working environment and nursing performance. in order to succeed in this process, it is advisable to initiate constructive training of nurses along with the introduction of increase in human resources, new equipment and restructuring of the responsibilities list. Training will contribute to development and acceptance of non-blaming culture among the employees as well as to elimination of other existing barriers. The value of additional education is supported in the study by Tshiamo, Kgositau, Ntsayagae, and Sabone (2015). Safarpour, Tofighi, Malekyan, Bazyar, Varasteh, and Anvary (2017) also support this stance. The researchers focus on the nursing curricula in Botswana (Tshiamo, Kgositau, Ntsayagae, & Sabone, 2015). Review and analysis of the curricula and gaps in nursing performance leads to the conclusion about strengthening basic nursing curricula at two crucial levels, namely, at diploma and undergraduate ones (Tshiamo, Kgositau, Ntsayagae, & Sabone, 2015). Solid education with both theoretical knowledge and practical skills can contribute to prevention of medications errors (Tshiamo, Kgositau, Ntsayagae, & Sabone, 2015). Evaluation of risks based on the previously committed errors will lead to better performance and higher level of safety.

Methodology

The present study is proposed to employ qualitative research in order to cover all the important aspects raised in the given research. According to Hancock, Ockleford, and Windridge (2009), qualitative research focuses on reality, people, and attitudes. Furthermore, it takes account of complexity by incorporating the real-world context can take different perspectives on board (Hancock, Ockleford, & Windridge, 2009, p. 6). The scholars also underline that this type of research does not involve manipulation of variables as far as it studies behavior in natural settings or uses people’s accounts as data (Hancock, Ockleford, & Windridge, 2009, p. 6). To be more precise, qualitative research concentrates on empirical reports, actual current experience or the data that cannot be expressed numerically in a proper and comprehensive manner (Hancock, Ockleford, & Windridge, 2009). Finally, this type of research also permits the scholars to either evaluate the studied phenomenon, or develop a novice concept based on the investigation conducted (Hancock, Ockleford, & Windridge, 2009). Since the present study aims to evaluate perceptions of nurses to reporting on voluntary errors and near miss incidents, qualitative research is the most suitable option.

Study Design

The present proposed research will be conducted as a cross-sectional study. It will be an observational study that is aimed at collecting evidence and analyzing it without interventions or modifications of this evidence. According to Mann (2003), such studies are targeted to evaluate, determine prevalence, and all the measurements are made within one particular point in time. Prevalence is vitally important to the clinician because it influences considerably the likelihood of any particular diagnosis and the predictive value of any investigation (Mann, 2003, p. 56). In the given context, prevalence of perceptions of nurses in reporting the errors impacts their effectiveness as professionals and level of patient safety. The present investigation will employ a questionnaire in order to acquire necessary data. The main advantages of the chosen study design include the comparatively little time required, minimal expenses, and acquisition of itemized valuable information needed for the study (Sedgwick, 2014). The major disadvantage of the given study is that there may be a non-response bias on the final stage of investigation (Sedgwick, 2014). Therefore, a back up group can be formed in order to prevent this potential risk to the study’s validity and credibility.

Study Setting

As the chosen study design implies, a small percentage of all the target population to be studied, it is crucial to select the most relevant setting to conduct this study properly. The setting will be hospital X. The hospital has 11 units. This means that the number of potential respondents will be sufficient for the scale of the study.

Study Population and Sampling

This contemporary research will not repeat the previous practices of researchers who endeavored to study the whole population and failed (Banerjee & Chaundhiry, 2010). Current scholars study a small part of the target population and then make inferences based on the acquired data for the whole population of its particular layer (Banerjee & Chaundhiry, 2010). Some proponents of modern research claim that it is crucial to have representative samples taken from a well-defined and real population, especially when it is a medical research (Goldstein et al., 2015). Furthermore, the scholars posit that the key scientific criterion should be the attempt to replicate (generalize) findings across different populations and groups (Goldstein et al., 2015, p. 447). Nevertheless, the present study requires a narrower focus so as to present a valid pattern that can later be expanded by means of further studies or employed as a background for improvements in reporting practice in hospital X in the nearest future. Therefore, one hospital was chosen for this investigation. It will provide the researchers with itemized data on the issue in question as well as a solid background for interventions in the field of research for the hospitals with similar pictures.

It is crucial to distinguish properly between target population and the sample. According to Hanlon and Larget (2011), the term population constitutes for all the individuals or units of interest; typically, there is not available data for almost all individuals in a population (p. 7). Along with this, the meaning of the term sample is as follows: a subset of the individuals in a population; there is typically data available for individuals in samples (Hanlon & Larget, 2011, p. 7). Hence, the target population in the given study is nursing personnel, whereas the sample of the study will involve 220 nurses, namely, 20 ones from each department of the hospital. Since there are 11 departments, the sample is expected to be 220 responses provided that all questionnaires will be completed without non-response bias.

Measurement Instrument

The ultimate measurement instrument in the given study will be a questionnaire. A questionnaire is a data collection instrument that encompasses a set number of questions aiming to collect information from respondents and contribute to the study. According to Brinkman (2009), it is a rather ambivalent instrument that can be effective only provided its relevant and justified construction. Therefore, the extensive literature review was conducted prior to development of a set of questions for this study. Based on the data acquired via the course of secondary research, i.e., review of credible, authentic and up-to-date sources, a questionnaire for the study was created. There are 25 questions, both open-ended and close-ended ones. Such a choice was caused by the need of both precise and clear data in order to identify basic tendencies in nurses’ perceptions of voluntary errors and near miss cases reporting and at the same time to acquire more itemized and personalized information on the core aspects of the topic. Therefore, there will also be a free space for each respondent to add any data he or she considers to be relevant for the given study. This additional information will also be analyzed as will be the nuances that were missed by the researchers but were essential, according to respondents opinion.

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Plan for Data Collection

The plan for data collection consists of the following steps: 1) the researcher is ________; 2) the researcher is responsible for the collection of data that will transpire in hospital X; 3) the researcher will discuss the given study with the hospital’s administration in order to receive a permission to conduct it; 4) subsequently, personnel will be informed about the study at a brief meeting organized in hospital. The nursing personnel will also receive letters via e-mail with details of the given study and terms of their participation. The letters will highlight that participation is voluntary, the confidence in the data provided is guaranteed, and the outcomes of the study will be used only for research purposes. The informed consent form will be attached; 5) as soon as the researcher receives consent on participation from 220 nurses from the hospital, all the nurses will receive the next letter, namely, the one with the link to the questionnaire. The study will be conducted in an online form so as not to interfere with the working process in the hospital as well as in order to provide the respondents with freedom to choose a relevant time for this activity. The participants will be given six days to complete the questionnaire. In case some questionnaires will not be returned by the respondents or will be incomplete, the back-up group will be contacted. This group will be formed simultaneously with the core group and will consist of 12 nurses from the same hospital. The core group will be formed on the basis of the first received consents, and only after that the back-up one will be established. The participants from the latter group will be informed about their role and potential dates they may receive the questionnaires; 6) once all the 220 responses are collected, all 232 nurses will receive a thank-you note and an invitation to the conference dedicated to the presentation of the study outcomes.

Plan for Data Management and Analysis

The data collected by means of the questionnaire will be managed in the following way: 1) all the responses to the questions will be structured accordingly to their leading topic; 2) the additional data will be separated for separate review; 3) the responses will be analyzed; 4) the report will be created. This report will consist of eight parts, seven of which will refer to the research questions claimed in the study, and the last one will address additional information acquired during the investigation; 5) the major outcomes of the study will be collected in a brief brochure aimed at informing the target audience about the key aspects of the nurses perceptions of reporting their errors along with recommended interventions. The report and brochure will be presented in both printed and online versions.

Ethical Considerations

The present study will rely on several core ethical considerations. First, anonymity and confidence will be guaranteed to the participants. To be more precise, the personal data of the participants such as email addresses will be given full confidentiality and used only to contact the participants in terms of the study, whereas their responses will be absolutely anonymous. Furthermore, the principle of informed consent will also be guaranteed. This principle implies that the letter with links to the questionnaire will be sent only after potential participants confirm that they are willing to partake in the given study. This will be actualized via informed consent form provided in the first letter.

Limitations

The proposed study has several limitations. First, it will cover only one hospital. Second, it may face non-response bias due to the chosen study design and form of conducting the survey. Third, the limited scale of the research will position it as an exemplar but restricted research accomplishment. These limitations will not decrease the overall value of the given study, but at the same time, it will not be used as a sample for generalized inferences in the scope of interest. Instead, such an investigation will be a valuable contribution to the localized research and will expand the potential of improvement involuntary error and near miss reporting by nurses.

Pre-Test

The pre-test will be conducted two weeks before the start of the actual investigation. Five colleagues of the researcher employed at hospital X will partake in the pre-test process. Once they complete the questionnaire, the following aspects will be addressed and analyzed: level of comprehensiveness and clarity of questions; sufficiency of the responses provided to the set questions for the purpose of the study; relevance between the expected information and the one actually provided. Based on these aspects, analysis will be conducted and, subsequently, necessary corrections and adjustments to the study process will be made.

Work Plan and Budget

The overall budget is expected to be minimal as far as this type of research is maximally economical. Therefore, preliminary calculations amount to $____. The main part of this sum will be spent on transport and organization of venues.

The time schedule developed for the proposed study covers four months and consists of the following steps: 1) preliminary research, development of the measurement tool, and other aspects of the study 6 weeks; 2) communicating the information of the study to the hospital’s authorities and then to its employees 1 week; 3) informing the potential participants and receiving informed consent forms 1,5 week; 4) collection of responses on the questionnaire 2 weeks; 5) analysis of the acquired data 4 weeks; 6) conducting a conference and initial distribution of the report and the brochures 1,5 week.

Plan for Dissemination and Implementation of Results

The acquired research outcomes will be organized into a detailed report and a brief brochure. The report will be used for academic purposes, whereas the brochure will be more useful for hospitals for practical implementation of results. The report will be presented at a conference that will be conducted at hospital X and dedicated specifically to the outcomes of this study. Along with this, the report will be sent to such journals as ______ and _____. The brochure will be distributed among the local hospitals in order to present the outcomes of research as well as recommended adjustments and innovations regarded as contributions to better voluntary error and near miss reporting by nurses. Furthermore, a brochure will be available online at the web site _____. These steps will ensure that the study outcomes will be used empirically in other hospitals contributing to better nursing performance and patient safety. It is possible to supply the brochure with the evidence of implemented changes in hospital X in the future in order to demonstrate their efficiency in practice.