Patient perspectives on adverse event investigations in health care.

BACKGROUND: Over the last decade attention has grown to give patients and next of kin (P/N) more substantial roles in adverse event investigations. Adverse event investigations occur after adverse events that resulted in death or severe injury. Few studies have focused on patient perspectives on their involvement in such investigations. The present study sets out to investigate how P/N and patient representatives (client councils and the Patient Federation Netherlands) view the involvement of P/N in adverse event investigations, particularly whether and why they want to involved, and how they want to shape their involvement. METHODS: The study features qualitative data on three levels: interviews with P/N (personal), focus groups with representatives of client councils (institutional), and an interview with the Patient Federation Netherlands (national). Researchers used inductive, thematic analysis and validated the results through data source triangulation. RESULTS: The initiative taken by the hospitals in this study provided P/N with the space to feel heard and a position as legitimate stakeholder. P/N appreciated the opportunity to choose whether and how they wanted to be involved in the investigation as stakeholders. P/N emphasized the need for hospitals to learn from the investigations, but for them the investigation was also part of a more encompassing relationship. P/N's views showed the inextricable link between the first conversation with the health care professional and the investigation, and the ongoing care after the investigation was finalized. Hence, an adverse event investigation is part of a broader experience when understood from a patient perspective. CONCLUSIONS: An adverse event investigation should be considered as part of an existing relationship between P/N and hospital that starts before the investigation and continues during follow up care. It is crucial for hospitals to take the initiative in the investigation and in the involvement of P/N. P/N motivations for involvement can be understood as driven by agency or communion. Agentic motivations include being an active participant by choice, while communion motivations include the need to be heard.

Beyond medical errors: exploring the interpersonal dynamics in physician-patient relationships linked to medico-legal complaints.

BACKGROUND: Previous research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients' cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints. METHODS: We conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke's approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes. RESULTS: Thematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician's work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians. CONCLUSIONS: This study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians' skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients.

"Learn from Errors": Post-traumatic growth among second victims.

BACKGROUND: Second victims, defined as healthcare providers enduring emotional and psychological distress after patient safety incidents (PSIs). The potential for positive transformation through these experiences is underexplored but is essential for fostering a culture of error learning and enhancing patient care. OBJECTIVE: To explore the level and determinants of post-traumatic growth (PTG), applying the stress process model. METHODS: The study was conducted at a tertiary general hospital in Chongqing, China. A descriptive, cross-sectional study design was used. A total of 474 s victims were included. An online survey was conducted in November 2021 to assess various factors related to the second victim experience. These factors included PSIs (considered as stressors), coping styles, perceived threats, and social support (acting as mediators), as well as the outcomes of second victim syndrome (SVS) and PTG. Statistical description, correlation analysis, and structural equation modeling were utilized for the data analysis. A p-value ≤ 0.05 was considered to indicate statistical significance. RESULTS: The participants reported moderate distress (SVS = 2.84 ± 0.85) and PTG (2.72 ± 0.85). The total effects on SVS of perceived threat, negative coping, social support, positive coping, and PSIs were 0.387, 0.359, -0.355, -0.220, and 0.115, respectively, accounting for 47% of the variation in SVS. The total effects of social support, positive coping, and PSIs on PTG were 0.355, 0.203, and - 0.053, respectively, accounting for 19% of the variation in PTG. CONCLUSIONS: The study provides novel insights into the complex interplay between perceived threats, coping styles, and social support in facilitating PTG among second victims. By bolstering social support and promoting adaptive coping strategies, the adverse effects of PSIs can be mitigated, transforming them into opportunities for resilience and growth, and offering a fresh perspective on managing PSIs in healthcare settings.

Second victim phenomenon among healthcare students: A scoping review.

AIM: This study aims to explore the "second victim" phenomenon in healthcare professions students following an adverse event. BACKGROUND: In healthcare settings, adverse events affect not only patients but also the involved healthcare personnel, who experience a wide range of physical and psychological responses, a situation known as the second victim phenomenon. This phenomenon also extends to students in health-related professions during their clinical training, yet there needs to be more research specifically addressing this group. DESIGN: A scoping review METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. In December 2023, we conducted a comprehensive database search in PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, Web of Science (WoS), Scopus and the Virtual Health Library (VHL). The review included original research studies of any design that focused on the second victim phenomenon among students, published in English, Spanish, German or Portuguese, with no restrictions on the publication date. The review was reported according to PRISMA-ScR guidelines. RESULTS: Seven studies were selected, primarily involving nursing and medical students. Common triggers of the second victim phenomenon in students were medication errors, patient falls and procedural errors. Described symptoms ranged from emotional distress, such as stress and hypervigilance, to physical symptoms, like sleep disturbances. Among the factors that influenced how this "second victim" phenomenon manifested in students were the reactions of their peers and the lack of support from supervisors. Contrary to the three possible outcomes described for professionals as second victims (surviving, thriving, or leaving), students are only described with two: giving up or moving on. CONCLUSION: The studies highlighted the crucial role of peer and supervisor support in managing such difficult situations. The results suggest that additional research is necessary in other healthcare disciplines. Educational and healthcare institutions should improve their preventive and management strategies to address the phenomenon's impact on students.

Medical Professionals' Responses to a Patient Safety Incident in Healthcare.

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

Do nursing students' altruism levels affect their attitudes toward medical errors? A cross-sectional study.

AIM: The aim of the current research is to determine nursing students' levels of altruism, attitudes towards medical errors and the effect of altruism on attitudes towards medical errors. BACKGROUND: Nursing students should be aware of medical errors and have an attitude towards correcting them. Professional values play an essential role in changing, shaping and developing attitudes in nursing students. Altruism is one of the most important determining professional values in students' professional success and development of attitudes towards different situations. DESING: This study is a descriptive and cross-sectional study. METHODS: The research was conducted in the Nursing Department of a state university in Turkey and the study population consisted of 2nd, 3rd and 4th year nursing students (N=375) who were continuing their education and clinical practice in the spring semester of the 2022-2023 academic year. The study was completed with 321 students. The data were collected online using the information form, the Altruism Scale and the Scale of Attitudes Towards Medical Errors via Google Forms between 01 and 31 May 2023. Data were analysed using descriptive statistics, Independent-Samples t-test, One-Way ANOVA test, Pearson's correlation analysis and simple linear regression. RESULTS: Students had a mean score of 69.68 (range 40-98) on the Altruism Scale and 3.82 (range 2.38-4.56) on the Scale of Attitudes Towards Medical Errors. A significant, very weak positive correlation was found between the Altruism Scale and the total mean scores of the Attitudes Towards Medical Errors Scale (p=0.001). Altruism was found to have a significant effect on attitude towards medical errors (p=0.001). The explanatory power of the regression model was 0.101 and altruism explained 10.1 % of the students' attitudes towards medical errors scores. CONCLUSIONS: Students have positive attitudes towards medical errors, high awareness of the importance of medical errors and error reporting and above average levels of altruism. Altruism has a positive effect on attitudes towards medical errors.

Adverse events and perceived abandonment: learning from patients' accounts of medical mishaps.

BACKGROUND: Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed. OBJECTIVE: To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment. METHODS: Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt 'that the doctors abandoned or betrayed you or your family'. Open-ended responses were analysed with a coding schema by two clinician coders. RESULTS: Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians. LIMITATIONS: Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period. CONCLUSION: Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians.

Nurses' perspectives and experiences on medical errors: A qualitative study.

INTRODUCTION: Medical errors are among the most important factors that threaten patient safety. Therefore, nurses' perspectives and experiences about medical errors are important for this manner. AIMS: The aim of this study was to determine in depth the perspectives and experiences of nurses related to how they define medical error, as well as its causes, management and reporting. DESIGN: This descriptive, exploratory study involved a qualitative design. METHODS: A total of 15 clinical nurses from eleven provinces were reached by snowball sampling method. In the study, nurses' perspectives on medical errors were obtained through semistructured in-depth online interviews conducted based on phenomenological methods. Descriptive analysis was used in the analysis of the data obtained from the interviews. The research was conducted following the COnsolidated criteria for REporting Qualitative checklist. RESULTS: The resulting 26 codes were categorized under seven themes: "Definition of medical error", "Experience of medical errors", "Frequency of medical errors", "Causes of medical errors", "Reporting of medical errors", "Medical error approach" and "Prevention of medical errors". CONCLUSIONS: The results show that it is still necessary to increase the awareness of nurses about medical errors and the importance of error reporting. In addition, it reveals the need for leadership to eliminate the negative approach to medical errors and shows that nurse managers should be empowered accordingly. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: It is the first step of quality and safe care to reveal nurses' perspectives on medical errors, their thoughts about medical errors and their experiences about errors in their institutions. In this study, nurses' knowledge, opinions and experiences regarding medical errors were revealed in this qualitative study. Therefore, this study offers important clues to nursing services, hospital managers and policy makers for clinical and institutional arrangements.

Exploring the fear of clinical errors: associations with socio-demographic, professional, burnout, and mental health factors in healthcare workers - A nationwide cross-sectional study.

Background: The fear of clinical errors among healthcare workers (HCW) is an understudied aspect of patient safety. This study aims to describe this phenomenon among HCW and identify associated socio-demographic, professional, burnout and mental health factors. Methods: We conducted a nationwide, online, cross-sectional study targeting HCW in France from May to June 2021. Recruitment was through social networks, professional networks, and email invitations. To assess the fear of making clinical errors, HCW were asked: "During your daily activities, how often are you afraid of making a professional error that could jeopardize patient safety?" Responses were collected on a 7-point Likert-type scale. HCW were categorized into "High Fear" for those who reported experiencing fear frequently ("once a week," "a few times a week," or "every day"), vs. "Low Fear" for less often. We used multivariate logistic regression to analyze associations between fear of clinical errors and various factors, including sociodemographic, professional, burnout, and mental health. Structural equation modeling was used to explore how this fear fits into a comprehensive theoretical framework. Results: We recruited a total of 10,325 HCW, of whom 25.9% reported "High Fear" (95% CI: 25.0-26.7%). Multivariate analysis revealed higher odds of "High Fear" among males, younger individuals, and those with less professional experience. High fear was more notable among physicians and nurses, and those working in critical care and surgery, on night shifts or with irregular schedules. Significant associations were found between "High Fear" and burnout, low professional support, major depressive disorder, and sleep disorders. Conclusions: Fear of clinical errors is associated with factors that also influence patient safety, highlighting the importance of this experience. Incorporating this dimension into patient safety culture assessment could provide valuable insights and could inform ways to proactively enhance patient safety.

Patient safety culture perceptions among dentists in the eastern region of Saudi Arabia.

OBJECTIVE: Safe patient care can help reduce treatment costs, morbidity, and mortality. This study aimed to assess dentists' perceptions of patient safety culture and related factors in the Eastern region of Saudi Arabia. METHODS: This cross-sectional study used a sample of 271 dental professionals working in private and public dental hospitals and clinics in the Eastern region of Saudi Arabia. The Safety Attitude Questionnaire (SAQ), a validated tool consisting of 36 items on a 5-point Likert scale, was used to assess dentists' perceptions of patient safety culture. The score of SAQ ranges from 0 to 100 and a cut-off ≥ 75 is considered a positive attitude toward patient safety culture. RESULTS: There were 53.9% males and 46.1% females in the study with a mean age of 35.56 ± 6.87 years. Almost half of the participants (52%) attended a course on patient safety and 22.1% experienced medical error in the last month. The mean score of the SAQ of the sample was 65.14 ± 13.03 and the patient safety score was significantly related to the marital status (P = 0.041), attendance of patient safety course (P < 0.001), and experience of medical error (P = 0.008). The highest mean score (73.27 ± 20.11) was for the job satisfaction domain, followed by the safety climate domain (67.69 ± 16.68), and working conditions domain (66.51 ± 20.43). About one-quarter of the participants (22.5%) demonstrated positive attitudes toward patient safety culture. Multiple logistic regression analysis showed that dental professionals who attended a patient safety course were 4.64 times more likely to demonstrate positive attitudes toward patient safety than those who did not attend a course (P < 0.001). CONCLUSION: This study showed that patient safety culture was significantly related to the attendance of safety courses, marital status, and experiencing medical error. About one out of four dental professionals demonstrated a positive attitude towards patient safety culture which was significantly associated with the attendance of the safety course.

Nurses' Risk Perception of Adverse Events and Its Influencing Factors: A Cross-Sectional Study.

To investigate clinical nurses' perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses' Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses' perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P < .01), head nurses' leadership behavior (r = .348, P < .01), and nurse safety behavior (r = .457, P < .01), and negatively correlated with the level of burnout (r = -.384, P < .01). According to the Regression analysis, nurses' departments (ß = .226, P < .001), daily working hours (ß = 1.122, P < .001), adverse events experience (ß = -1.505, P < .001), organizational support (ß = .105, P < .001), head nurses' leadership behavior (ß = .072, P < .001), and burnout (ß = -.052, P < .001) held an influence on nurses' risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses' risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses' burnout, improve nurses' risk perception of adverse nursing events, prevent adverse events, and ensure patient safety.

Quality of Care and Quality of Life: Balancing Patient Safety and Physician Burnout.

Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician well-being, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians.

Surgeon and Surgical Trainee Experiences After Adverse Patient Events.

Importance: Adverse patient events are inevitable in surgical practice. Objectives: To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient. Design, Setting, and Participants: In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system. Main Outcomes and Measures: The personal impact of adverse patient events, current coping mechanisms, and desired forms of support. Results: Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing. Conclusions and Relevance: In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

Assessing the stops framework for coping with intraoperative errors: Evidence of efficacy, hints of hubris, and a bridge to abridging burnout.

BACKGROUND: Answering calls in the literature, we developed and introduced an evidence-based tool for surgeons facing errors in the operating room: the STOPS framework (stop, talk to you team, obtain help, plan, succeed). The purpose of this research was to assess the impact of presenting this psychological tool on resident coping in the operating room and the related outcome of burnout while examining sex differences. METHODS: In a natural experiment, general surgery residents were invited to attend 2 separate educational conferences regarding coping with errors in the operating room. Three months later, all residents were asked to fill out a survey assessing their coping in the operating room, level of burnout, and demographics. We assessed the impact of the educational intervention by comparing those who attended the coping conferences with those who did not attend. RESULTS: Thirty-five residents responded to the survey (65% response rate, 54% female respondents, 49% junior residents). Our hypothesized moderated mediation model was supported. Sex was found to moderate the impact of the STOPS framework-female residents who attended the coping educational conference reported higher coping self-efficacy, whereas attendance had no statistically significant impact on male levels of coping self-efficacy. In turn, higher coping self-efficacy was associated with lower levels of burnout. CONCLUSION: Our results suggest that there is evidence of efficacy in this instruction-female residents presented this material report higher levels of coping in the operating room compared to those who did not receive the framework. Further, increase in coping ability was associated with reduced levels of burnout for both genders.

The Role of Pediatric Nurses During Preventable Adverse Event Disclosure: A Scoping Review.

OBJECTIVES: Preventable adverse events (PAEs) occur across the healthcare spectrum; and, unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure? METHODS: The Arksey and O'Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting. RESULTS: The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure. CONCLUSIONS: There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family.

Is there a relationship between nursing students' perceptions of dishonesty and attitudes towards medical errors?

BACKGROUND: Understanding nursing students' perceptions of dishonesty and their attitudes towards medical errors is crucial for nurse educators. OBJECTIVES: This study aimed to examine the relationship between nursing students' perceptions of dishonesty and their attitudes towards medical errors. DESIGN: This study is descriptive and correlational research. The sample size consisted of 230 nursing students in a Department of Nursing at Kirsehir Ahi Evran University Faculty of Health Sciences in Turkey during the 2022-2023 academic year. The data was collected between May 15-31, 2023. RESULTS: A statistically significant correlation was observed between the total score of the Nursing Student Perceptions of Dishonesty Scale, and the Medical Errors Attitude Scale (p < 0.05). There was a positive and weak correlation between the MEAS scale score and the cheating (r = 0.284, p < 0.05), sabotage (r = 0.275, p < 0.05), perjury (r = 0.308, p < 0.05), non-compliance (r = 0.309, p < 0.05), and stealing (r = 0.359, p < 0.05) sub dimension score, and a positive and very weak correlation between the MEAS score and the sub dimension of not my problem score (r = 0.182, p < 0.05). The perceptions of dishonesty explain 15 % of the attitude towards medical errors (F = 4.563, p < 0.001). CONCLUSIONS: In this study, a significant relationship was observed between nursing students' perceptions of dishonesty and their attitudes towards medical errors. Specifically, as the perception of dishonesty increased, there was a positive change in attitudes towards medical errors. These results offer nurse educators valuable insights into the impact of academic dishonesty on the development of medical error attitudes among student nurses throughout their nursing education and beyond.

Lebanese medical students' attitudes towards patient safety and medical error disclosure: A cross-sectional study.

OBJECTIVE: To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure. METHODS: This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected. RESULTS: Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of 'Team functioning' followed by 'Working hours as an error cause'. More positive attitudes were perceived among male students in the domains of 'Professional incompetence as an error cause' and 'Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of 'Working hour as an error cause'. Older medical students had more positive attitudes in the domain of 'Team functioning' than younger students. CONCLUSION: Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon.