Researchers from disciplines of education, health communication, law and risk management, medicine, nursing, and pharmacy examined communication tensions among interprofessional (IP) health care providers regarding medical error disclosure utilizing patient simulation. Using relational dialectics theory, we examined how communication tensions manifested in both individual-provided medical error disclosure and IP team-based disclosure. Two dialectical tensions that health care providers experienced in disclosure conversations were identified: (a) leadership and support, and (b) transparency and protectionism. Whereas these tensions were identified in an IP education setting using simulation, findings support the need for future research in clinical practice, which may inform best practices for various disclosure models. Identifying dialectical tensions in disclosure conversations may enable health communication experts to effectively engage health care providers, risk management, and patient care teams in terms of support and education related to communicating about medical errors.
AdamoG. (2003). Simulated and standardized patients in OSCEs: Achievements and challenges 1992-2003. Medical Teacher, 25, 262–270. doi:10.1080/0142159031000100300
ApkerJ.ProppK. M.FordW. S. Z. (2005). Negotiating status and identity tensions in health care team interactions: An exploration of nurse role dialectics. Journal of Applied Communication Research, 33, 93–115. doi:10.1080/00909880500044620
9.
BarrowsH. S. (1993). An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine, 68, 443–451.
10.
Bauer-WuS.YeagerK.NorrisR. L.LiuQ.HabinK. R.HayesC.JurchakM. (2009). Communication and planning at the end-of-life: A survey of women with advanced stage breast cancer. Journal of Communication in Healthcare, 2, 371–386. doi:10.1179/cih.2009.2.4.371
11.
BaxterL. A. (1988). A dialectical perspective on communication strategies in relationship development. In DuckS. W.HayD. F.HobfollS. E.IchesW.MontgomeryB. (Eds.), Handbook of personal relationships (pp. 257–273). London: John Wiley.
12.
BaxterL. A.BraithwaiteD. O. (2007). Social dialectics: The contradictions of relating. In WhaleyB. B.SamterW. (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 275–292). Mahwah, NJ: Lawrence Erlbaum.
13.
BaxterL. A.BraithwaiteD. O.GolishT. D. (2002). Contradictions of interaction for wives of elderly husbands with adult dementia. Journal of Applied Communication Research, 30, 1–26. doi:10.1080/00909880216576
14.
BaxterL. A.MontgomeryB. M. (1996). Relating: Dialogues and dialectics. New York: Guilford Press.
15.
BaxterL. A.MontgomeryB. M. (1998). A guide to dialectical approaches to studying personal relationships. In MontgomeryB. M.BaxterL. A. (Eds.), Dialectical approaches to studying personal relationships (pp. 1–15). Mahwah, NJ: Lawrence Erlbaum.
16.
BoeijeH. (2010). Analysis in qualitative research. London: Sage.
BronsteinL. R. (2003). A model for interdisciplinary collaboration. Social Work, 48, 297–306. doi:10.1093/sw/48.3.297
21.
CarmackH. J. (2014). A cycle of redemption in a medical error disclosure and apology program. Qualitative Health Research, 24, 860–869. doi:10.1177/1049732314536285
22.
CarstenM. K.Uhl-BienM. (2013). Ethical followership: An examination of followership beliefs and crimes of obedience. Journal of Leadership & Organizational Studies, 20, 49–61. doi:10.1177/1548051812465890
23.
Center for Advancement of Interprofessional Education. (2018). Available from http://www.caipe.org.uk
24.
ClelandJ. A.AbeK.RethansJ. J. (2009). The use of simulated patients in medical education: AMEE Guide No 42. Medical Teacher, 31, 477–486.
25.
CorbinJ.StraussA. (2008). The basics of qualitative research: Techniques and procedures developing grounded theory (4th ed.). Thousand Oaks, CA: Sage.
26.
DeanM.OetzelJ. G. (2014). Physicians’ perspectives of managing tensions around dimensions of effective communication in the emergency department. Health Communication, 29, 257–266. doi:10.1080/10410236.2012.743869
27.
DowA. W.Diaz GranadosD.MazmanianP. E.RetchinS. M. (2013). Applying organizational science to health care: A framework for collaborative practice. Academic Medicine, 88, 953–957. doi:10.1097/ACM.0b013e31829523d1
28.
FeinS. P.HilborneL. H.SpiritusE. M.SeymannG. B.KeenanC. R.ShojaniaK. G.. . . WengerN. S. (2007). The many faces of error disclosure: A common set of elements and a definition. Journal of General Internal Medicine, 22, 755–761. doi:10.1007/s11606-007-0157-9
29.
FordL. A.RayE. B.EllisB. H. (1999). Translating scholarship on intrafamilial sexual abuse: The utility of a dialectical perspective for adult survivors. Journal of Applied Communication Research, 27, 139–157. doi:10.1080/00909889909365531
30.
FreethD.ReevesS. (2004). Learning to work together: Using the presage, process, product (3P) model to highlight decisions and possibilities. Journal of Interpersonal Care, 18, 43–56. doi:10.1080/13561820310001608221
31.
GallagherT. H.WatermanA. D.EbersA. G.FraserV. J.LevinsonW. (2003). Patients’ and physicians’ attitudes regarding the disclosure of medical errors. Journal of the American Medical Association, 289, 1001–1007. doi:10.1001/jama.289.8.1001
32.
GlaserB. (1965). The constant comparative method of qualitative analysis. Social Problems, 12, 436–445. Retrieved from http://www.jstor.org/stable/798843
33.
HannawaA. F.BeckmanH.MazorK. M.PaulN.RamseyJ. V. (2013). Building bridges: Future directions for medical error disclosure research. Patient Education & Counseling, 92, 319–327. doi:10.1016/j.pec.2013.05.017
34.
HobgoodC.Tamayo-SarverJ. H.ElmsA.WeinerB. (2005). Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children. Pediatrics, 116, 1276–1286.
35.
HolquistM. (2002). Dialogism (2nd ed.). New York: Routledge.
36.
HoveyR. B.DvorakM. L.BurtonT.WorshamS.PadillaJ.HatlieM. J.MorckA. C. (2011). Patient safety: A consumer’s perspective. Qualitative Health Research, 21, 662–672. doi:10.1177/1049732311399779
37.
Institute of Medicine. (1999). To err is human. Washington, DC: National Academy Press.
38.
JamesJ. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9, 122-128.
39.
JeffsL.EspinS.RorabeckL.ShannonS.RobinsL.LevinsonW.. . . LingardL. (2011). Not overstepping professional boundaries: The challenging role of nurses in simulated error disclosures. Journal of Nursing Quality Care, 26, 320–327. doi:10.1097/NCQ.0b013e31822abf81
KachaliaA.KaufmanS. R.BoothmanR.AndersonS.WelchK.SaintS.RogersM. A. M. (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine, 153, 213–221. doi:10.7326/0003-4819-153-4-201008170-00002
42.
KaldjianL. C.JonesE. W.WuB. J.Forman-HoffmanV. L.LeviB. H.RosenthalG. E. (2007). Disclosing medical errors to patients: Attitudes and practices of physicians and trainees. Journal of General Internal Medicine, 22, 988–996. doi:10.1007/s11606-007-0227-z
43.
KramanS. S.HammG. (1999). Risk management: Extreme honesty may be the best policy. Annals of Internal Medicine, 131, 963–967. doi:10.7326/0003-4819-131-12-199912210-00010
44.
LiangB. A. (2002). A system of medical error disclosure. BMJ Quality & Safety, 11, 64–68. doi:10.1136/qhc.11.1.64
45.
MatzoM. L.ShermanD. W.SheehanD. C.FerrellB. R.PennB. (2003). Communication skills for end-of-life nursing care: Teaching strategies from the ELNEC curriculum. Nursing Education Perspectives, 24, 176–183.
46.
McDonoughK. A.WhiteA. A.OdegardP. S.ShannonS. E. (2017). Interprofessional error disclosure training for medical, nursing, pharmacy, dental, and physician assistant students. MedEdPORTAL, 13, 10606. doi:10.15766/mep_2374-8265.10606
MontgomeryB. M.BaxterL. A. (1998). Dialogism and relational dialectics In MontgomeryB. M.BaxterL. A. (Eds.), Dialectical approaches to studying personal relationships (pp. 155-184). Mahwah, NJ: Lawrence Erlbaum.
NolandC. M.CarmackH. J. (2014). “You never forget your first mistake”: Nursing socialization, memorable messages, and communication about medical errors. Health Communication, 30, 1234–1244. doi:10.1080/10410236.2014.930397
51.
NolandC. M.CarmackH. J. (2015). Narrativizing nursing students’ experiences with medical errors during clinical. Qualitative Health Research, 25, 1423–1434. doi:10.1177/1049732314562892
52.
OlufowoteJ. O. (2011). A dialectical perspective on informed consent to treatment: An examination of radiologists’ dilemmas and negotiations. Qualitative Health Research, 21, 839–852. doi:10.1177/1049732311402097
53.
RawlinsW. K. (1998). Writing about friendship matters: A case study in dialectical and dialogical inquiry. In MontgomeryB. M.BaxterL. A. (Eds.), Dialectical approaches to studying personal relationships (pp. 63–82). Mahwah, NJ: Lawrence Erlbaum.
54.
ShannonS. E.FogliaM. B.HardyM.GallagherT. H. (2009). Disclosing errors to patients: Perspectives of registered nurses. The Joint Commission Journal on Quality and Patient Safety, 35, 5–12. doi:10.1016/S1553-7250(09)35002-3
WeissP. M.MirandaF. (2008). Transparency, apology and disclosure of adverse outcomes. Obstetrics and Gynecology Clinics, 35, 53–62. doi:10.1016/j.ogc.2007.12.007
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