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J Patient Saf. 2013 Mar;9(1):1-7. doi: 10.1097/PTS.0b013e3182699919.

Barriers and facilitators to communicating nursing errors in long-term care settings.

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University of California San Francisco, School of Nursing, San Francisco, California, USA.



To explore nurses' perceptions about communicating nursing errors.


Cross-sectional, descriptive study.


Approximately 289 nurses working in long-term care facilities in Ontario, Canada.


A cross-sectional, descriptive study of approximately 289 nurses working in long-term care facilities in Ontario, Canada. Solicited nurses' perceptions concerning the disclosure of nursing errors and adverse events by including an open-ended item at the conclusion of a 60-item (multiple choice) questionnaire on the same topic. A qualitative content analysis was conducted using a multi-step process.


A total of 245 responses were included in the content analysis. The main categories related to error communication that were derived from the analysis were as follows: (1) differences in the definition of terms; (2) the day-to-day working conditions and their impact on defining and reporting errors; (3) organizational factors that both help and hinder the reporting of errors in ensuring both personal and organizational responsibility; (4) communication styles that both help and hinder disclosure and adherence to proper protocols; and (5) external factors such as policies and professional standards and codes of ethics, which can provide clarity of process; and (6) recommendations for implementation of professional standards in long-term care settings to facilitate supportive working conditions.


Eliminating the barriers to error communication requires moving toward a culture of safety. This involves both top-down and bottom-up approaches that allow nurses to feel comfortable being active participants in the error communication process.

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