Nurses’ Communication of Safety Events to Nursing Home Residents and Families


Laura M. Wagner, Lena Driscoll, Jasmin L. Darlington, Victoria Flores, Julee Kim, Katerina Melino, Hema Doshi Patel, and Joanne Spetz


Although communication is an essential part of the nursing process, nurses have little to no formal education in how to best communicate patient safety event (PSE) information to nursing home (NH) residents and their family members. The current mixed-methods study tested an intervention aimed at educating nurses on how to communicate a PSE to residents/family members using a structured communication tool. Nurse participants improved their knowledge of PSE communication, especially about the cause of the event, what they would say to the resident/family member, and future prevention of the PSE. Through qualitative subgroup analysis, an increased number of empathic statements were noted post-intervention. The tool tested in this study provides structure to an important care process that is necessary for improving the culture of safety in NH settings.

Identified areas for improving nurses PSE communication:

  • Responding to family members in a “mechanical” or “robotic” tone, rather than one that flowed naturally between the nurse and resident/family.
  • Including a statement blaming the resident for the cause of his/her fall in their explanation.
  • Including numerous statements that were not considerate of the family member’s level of health literacy.

Identified solutions:

  • Teaching nurses about the importance of listening to NH residents/families and allowing time for pauses and reflection during a conversation.
  • Allowing high-risk health care environments to be blame-free for all stakeholders, including residents, will help to encourage collaboration and commitment to address the root causes of PSEs.
  • Implementing a teaching strategy by including the substantive role the Anticipate, Listen, Empathize, Explain, Follow-up (ALEEF) model can play in structuring the PSE communication process with staff nurses as the key recipients of this education.

This study—the first to test the process of PSE communication among nurses—highlights the value of nursing contributions to safety and quality as well as factors that can improve the quality of care nurses provide. The ALEEF framework provides a structure to teach gerontological nurses about a communication process essential to their leadership role in further improving the culture of safety in NH care.