Iranian Journal of Medical Ethics and History of Medicine

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Reporting professional errors is an essential step towards improving patient safety not only in hospitals but also outpatient healthcare centers. Unfortunately, nurses, like many other members of the medical team, do not report most of their mistakes and errors in performance. The objective of this study was to assess possible determinants of the tendency to report nursing errors by exploring the experiences of clinical nurses and nursing managers in this regard. In this qualitative study, 115 nurses employed by hospitals and specialty clinics of Tehran and Shiraz Universities of Medical Sciences were enrolled. Data were collected through 17 sessions of semi-structured discussion groups, and contents were examined and analyzed based on an empirical-analytic approach. The main patterns observed in this study included 1) nurses' overall perception of error, 2) obstacles in reporting nursing errors, 3) motives of reporting error. Reporting errors can provide valuable information for prevention of future errors and improvement of patient safety. Overall, considering the obstacles and motives of reporting nursing errors, there is need for codes and regulations in which the process of reporting error and the components of error are clearly determined and defined.

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Although errors in health services are harmful and the consequences might be irreversible in some situations, none of the health care providers are free of errors. Since health provision is the main goal of the nursing care, it is important to report professional errors in order to reach this goal. However, there are many obstacles in reporting nursing errors that should be identified and solved. The present study tried to evaluate the nurses’ point of view about managerial and moral obstacles in expressing nursing errors.Two hundred and one nurses of the educational hospitals of Sabzevar University of Medical Sciences were enrolled in this descriptive analytic study. The students were selected by convenience sampling method and the study data was collected using a questionnaire that consisted of a demographic part and a researcher made part with 13 and 27 questions related to managerial and moral obstacles respectively. Content validity index and reliability were measured by internal consistency (α = 80) and test-retest (r = 0.84). Data analysis was done by SPSS 18 software.The results of this study showed that the main reported managerial obstacle in reporting nursing errors was endangerment of academic position (43.3%), and the main moral obstacle was losing physicians' support (55.2%). Thus this problem might be solved by designing appropriate plans from both managerial and moral points of view.

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Confidentiality has long been protected in criminal law as an important ethical principle. With regard to the issue of sexually transmitted diseases, however, health care providers are faced with certain challenges. On the one hand, it is their obligation and duty to respect patient confidentiality, and on the other hand, the possibility of transmission of infection to sexual partners is a rather significant phenomenon. Therefore, health care providers have a crucial role in terms of the conflict of interests and legal duties with respect to sexually transmitted diseases.Medical mandatory reporting to state authorities accompanied by personally identifiable information of the infected person is another controversial issue in the field of confidentiality, which will be discussed in this article by studying various trends in statutes and precedents. It seems that throughout the world, there are two major trends in this respect: in some states, principles of confidentiality are observed even if the patient is infected by sexually transmitted diseases, unless it is inevitable for the safety of third parties such as sexual partners in a narrow implementation of Acts. States like Iran, France and Thailand are examples of such governments. In some countries, however, partner notification and compulsory notification by personally identifiable information of patients are mandatory for epidemiologic reasons. The United States, Australia and Ukraine are some of the countries that fall within this category. In Iranian legal system, the duty to respect confidentiality is emphasized and partner notification cannot be considered as a legal duty and therefore it is not legally permitted. Merely in emergency condition and under a narrow interpretation of law and by resort to patients informed consent, necessity and explicit law permission, breaching of confidentiality is justified.

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