Developing a research tool to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals
Authors: Okkenhaug Arne , Tritter Jonathan Q. , Landstad Bodil J. 
Published: November 2023

Accessible Summary

What is known on the subject

Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their career

Norway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals

What the paper adds to existing knowledge

We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation

We have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool.

What are the implications for nurses

Applying the ‘Global Trigger Tool—Psychiatry’ in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.

Implementing ‘Global Trigger Tool—Psychiatry’ might help mental health nurses to improve patient safety in Norway and Sweden.

Introduction

There is little consensus on cross‐cultural and cross‐national adaptation of research instruments.

Aim/Question

To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process.

Method

The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records.

Results

We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument.

Discussion

We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses.

Implications for practice

When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings.