The Impact of Assessing Patients' Sense of Security on Nurses' Intent to Report Safety Events: A Factorial Survey Experiment

ABSTRACT

Aims

To evaluate whether information about patients' poor sense of security in hypothetical vignette scenarios increases nurses' projected intent to report safety events.

Design

Quantitative, cross-sectional factorial survey vignette experiment administered online.

Methods

A convenience sample of 60 nurses from adult inpatient hospital units at a Midwest academic medical center participated in February 2025. Participants responded to demographic questions and eight factorial vignettes, each describing a patient-reported safety breach and incorporating four patient-related factors. Four vignettes included information that the patient had a poor sense of security, and four did not, presented in random order. Following each vignette, participants rated their level of concern about the patient's report, perceived harm to the patient, and likelihood of reporting the patient's concern. A linear mixed-effects modelling approach, accounting for clustering within participants, was used to estimate the effects of the sense of security information factor on nurses' responses.

Results

The sense of security information was associated with higher ratings of (a) degree of concern, (b) perceived harm to the patient, and (c) intent to report the patient's concern, after adjusting for vignette- and participant-level covariates. The vignette patient's perception of physical harm was positively associated with all three ratings. Nurses' greater hospital experience was associated with lower ratings across outcomes.

Conclusion

Obtaining information that the patient felt insecure was associated with heightened concern about the safety event, greater perceived harm, and increased intent to report the concern.

Implications for the Profession and/or Patient Care

Sense of security assessment may be a risk-agnostic, patient-centered intervention that nurses can routinely perform, regardless of the safety event circumstances.

Impact

Although a system of evidence-based practices within a safety culture is essential to hospital safety efforts, nurses' judgements of and responses to patient safety concerns play a critical role and should not be overlooked.

Reporting Method

STROBE guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.