Perspectives on developing moral courage in pre-licensure education: A qualitative study.

BACKGROUND: Error reporting and speaking up are mechanisms to reduce the incidence of healthcare errors. However, organizational policies don't always align with individuals' perceptions and beliefs to promote these mechanisms. When this misalignment produces fear, moral courage, which is taking action regardless of personal consequences, becomes necessary. Teaching moral courage in pre-licensure education may set a foundation for individuals to speak up in post-licensure careers. AIM: To explore health professionals' perceptions of healthcare reporting and organizational culture to inform pre-licensure education on how to promote moral courage. METHODS: Thematic analysis of four semi-structured focus groups with fourteen health professions educators followed by in-depth, semi-structured individual interviews. FINDINGS: Organizational factors, characteristics that an individual must possess to enact moral courage and priority methods to guide moral courage were identified. CONCLUSIONS: This study outlines the need for leadership education in moral courage and offers educational interventions to promote reporting and aid in developing moral courage academic guidelines to improve healthcare error reporting and speaking up behaviors.

Individual Characteristics That Promote or Prevent Psychological Safety and Error Reporting in Healthcare: A Systematic Review.

Background: Healthcare errors continue to be a safety issue and an economic burden that causes death, increased length of stays, and emotional trauma to families and the person who commits the error.  Speaking up and error reporting within a safety culture can reduce the incidence of error; however, this is complex and multifaceted. Aim: This systematic review investigates individual characteristics that support or prevent speaking up behaviors when adverse events occur.  This study further explores how organizational interventions designed to promote error reporting correlate to individual characteristics and perceptions of psychological safety.  . Methods: A systematic review of peer-reviewed articles in healthcare that contain characteristics of an individual that promote or prevent error reporting was conducted. The search yielded 1233 articles published from 2015 to 2021. From this set, 81 full-text articles were assessed for eligibility and ultimately extracted data from 28 articles evaluated for quality using Joanna Briggs Institute critical appraisal tools©. Principal Findings: The primary themes for individual character traits, values, and beliefs that influence a person's decision to speak up/report an error include self-confidence and positive perceptions of self, the organization, and leadership. Education, experience and knowledge are sub themes that relate to confidence. The primary individual characteristics that serve as barriers are 1) self-preservation associated with fear and 2) negative perceptions of self, the organization, and leadership. Conclusion: The results show that an individual's perception of their environment, whether or not it is psychologically safe, may be impacted by personal perceptions that stem from deep-seated personal values. This exposes a crucial need to explore cultural and diversity aspects of healthcare error reporting and how to individualize interventions to reduce fear and promote error reporting.