Error detection and recovery in dialysis nursing

Objectives: Our aim for this study was to evaluate dialysis nurses' ability to detect and recover from nursing errors. Methods: Two clinical cases with a total of 12 embedded errors were constructed. The errors were based on real events but were modified for the experimental design by an expert dialysis nurse. A total of 31 registered nurse subjects "talked aloud" as they read through the 2 cases and answered a set of predesigned knowledge-based and procedural questions. The talk-aloud sessions were recorded and transcribed for analysis of errors detected and recovered. Results: Performance on procedurally based error detection and recovery was significantly higher as a function of expertise (P < 0.05), where more-experienced nurses performed better than the less-experienced nurses in detecting and recovering procedurally based errors. However, no differences were found for knowledge-based errors. Conclusions: Expert nurses develop a special ability to detect and recover from nursing errors, but the nature of these errors depends on the nature of the task. Dialysis nursing requires more knowledge of procedures rather than conceptual knowledge in their routine work, and thus, the nurses develop better procedurally based skills. This raises concern about nurses making knowledge-based or conceptual errors, which, if made, are not detected or corrected. The need for understanding conceptual knowledge underlying procedures and for training in error detection and correction strategies is discussed in the context of nursing.