Date of Graduation

Fall 12-14-2018

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions


Executive Leader DNP

First Advisor

Brian Budds, JD, MS, RN

Second Advisor

Mary Lynne Knighten, DNP, RN, PN, NEA-BC



Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and their families after discharge, as well as other measures, such as the number of concerns reported and caregiver confidence.

Intervention: This project aimed to translate existing evidence into practice to explore nurses’ ability to promote safety partnerships with patients and families.

Measures: This was measured by responses given by pediatric nurses working on one pediatric unit. A survey was administered before and after simulation training to evaluate the nurses comfort with these conversations. In addition, HCAHPS (also known as Hospital CAHPS) stands for Hospital Consumer Assessment of Healthcare Providers and Systems and is a standardized survey of hospital patients that captures patients' unique perspectives on hospital care for providing the public with comparable information on hospital quality. These are considered patient satisfaction scores and are reported post discharge. The trend in HCAHPS scores were reviewed to monitor for efficacy of the patient’s, patient’s, and family’s ability and comfort to speak up and report any errors and safety concerns. Lastly, the incident reporting system was used to track, trend, and compare reported events to near miss events by showing an increase in nurses identifying and reporting safety concerns before they occur. The simulation training was focused on communication, listening, and clarifying to facilitate a culture of safety between the nurses and the patient families. Listening carefully to the voice of the patient as part of the core care team is imperative for providing patient- and family-centered care that is conducive to learning and promotes an atmosphere of quality and safety. In patient- and family-centered care, patients and families define their “family” and determine how they will participate in care and decision-making. A key goal is to promote the health and well-being of individuals and families, and to maintain their control (Johnson, B.H. and Abraham, M.R., 2012).

Conclusions: This project produced both quantitative and qualitative results supporting this concept and the results demonstrated an improvement in HCAHPS scores reported by parents about their confidence in reporting mistakes or errors. The results of the post-simulation training survey exhibited growth in the nurse’s opinion about their abilities to have conversations with patients and families around safety and reporting mistakes. The total percentage is the number of parents or patients post discharge that reported that they were confident in reporting mistakes. In addition, other outcomes included staff participant confidence and comfort in reporting near misses or close calls in the units. This was demonstrated by an increase in nurse reported confidence through a survey before and after the intervention. Additionally, quantitative data from the incident reporting system in the organization resulted in an increase in near miss and close call events and a decrease in reported actual events in the unit where the intervention took place.

This information has continued to be reported monthly at shared governance committee meetings to ensure that staff members and the multidisciplinary team could see results and share comments as well as what was learned. Noteworthy outcomes from the project include an increase in HCAPS scores to the questions focused on reporting mistakes or near miss errors and/or events.

One goal was to increase the confidence in identifying and speaking up about concerns or near miss events. The number of actual events or harm that had occurred should be lower than reports of potential events. After the intervention, the number of entries in the organization's error reporting system that identified "near misses" or "close call events" increased from a total reported of three percent to thirty seven percent (67 out of a total of 125 reports). This increase displays a recognition by the nursing staff to report potential harm and near misses, not only actual mistakes; and speak up to prevent actual harm in future cases.