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AN EXPLORATION OF ACCIDENT/FAILURE ATTRIBUTIONS 1

AN EXPLORATION OF ACCIDENT/FAILURE ATTRIBUTIONS AND THE

POTENTIAL IMPLICATIONS FOR FUTURE RESEARCH IN

OCCUPATIONAL HEALTH PSYCHOLOGY WITH PSYCHIATRIC NURSES

By:

JUSTIN C. DESROCHES

Major Paper Presented as a Partial Requirement of the Masters of Arts (M.A.) in Interdisciplinary Health (INDH)

School of Graduate Studies Laurentian University

Sudbury, Ontario, Canada

© Justin Desroches, 2016


ACKNOWLEDGEMENTS

The completion of this project would not have been possible without a strong and

valued support system.

Firstly, I would like to thank my supervisor, Dr. Michel Larivière, whose

tremendous support, patience and guidance has not only allowed me to see this project

through, but also find myself within the vast and growing field of health. I have learned a

great deal from him over the past year and a half and I hope to bring his life lessons with

me to my future career.

Secondly, I would like to thank my committee members, Dr. Céline Larivière and

Professor Judith Horrigan PhD[c] whose interdisciplinary perspectives provided me with

valuable insight for this project. I would also like to thank them for their strong support.

Thirdly, I would like to thank Dr. Zsuzsanna Kerekes who helped me prepare this

project for an international conference in Greece, Athens at the European Academy of

Occupational Health Psychology.

Fourth, I would like to thank my family and friends who have motivated me

throughout the pursuit of my graduate school education and have acknowledged my hard

work throughout this process. A special thanks also goes out to my father and Northern

Safety Solutions Inc. who inspired a research interest in occupational health and safety.

Lastly, I would like to acknowledge my program coordinator, Dr. Shelley Watson

who supported me with this project’s timelines and necessary steps towards completion.

Overall, I am grateful for the academic experiences I have gained throughout this

project as well as my degree and I am thrilled for the next step life has to offer me...


ABSTRACT

The current review of the literature provides an overview of Attribution Theory (AT)

and the themes, trends and gaps that have emerged for this construct within the field of

occupational health psychology. AT is a widely published area of research and has

served as a theoretical framework to investigate how individuals interpret accidents

and their causes. Within this framework, researchers have investigated cognitive

biases such as the selfserving bias, the false consensus effect, the actorobserver bias,

the fundamental attribution error, the ultimate attribution error, Fischoff’s hindsight

bias, the hedonic relevance bias, the optimism bias, and defensive attribution theory.

Themes and trends of this review include subjective attribution tendencies, the types

of attributions and their relation to safety behaviours, controversies regarding the

assumptions of responsibility and the importance of accurate accident appraisals.

Current gaps in the literature include somewhat dated research and only partial use of

Weiner’s AT model (1985; 2010). In addition, there seems to be a paucity of research

on AT as it applies to occupations with a high prevalence of accidents such as

psychiatric nursing. The review further describes the extent to which the theory may

be useful for occupational health and safety, accident prevention and in psychiatric

nursing where practitioners face not only the common risks inherent to the profession

but also the significant and unique risks in mental health facilities such as patient

aggression and violence. This paper concludes by suggesting avenues of possible

research as it applies to this profession, methodological challenges and the

implications for future studies.


TABLE OF CONTENTS

ACKNOWLEDGEMENTS…………………………………………………………… 2

ABSTRACT………………………………………………………………………….... 3 PSYCHIATRIC NURSES AND OCCUPATIONAL ACCIDENTS………………….. 6

Challenges in the Nursing Profession…………………………………………….... 6 Factors Contributing to Injury, Absenteeism and Emotional Exhaustion………….. 8 The Perspective of Psychiatric Nurses……………………………………………... 12

ATTRIBUTION THEORY: ORIGIN AND CONTRIBUTORS……………………....14

Heider’s Naïve Psychology………………………………………………………... 14 Jones and Davis’s Correspondent Inference Theory………………………………. 15 Kelley’s Covariation Theory………………………………………………………. 16 Weiner’s Model for Achievement Related Events……………………………….... 16

ATTRIBUTION BIASES AND THEORY………………………………………….... 18

SelfServing Bias…………………………………………………………………... 18 False Consensus Effect…………………………………………………………….. 18 ActorObserver Bias……………………………………………………………….. 18 Fundamental Attribution Error…………………………………………………….. 18 Ultimate Attribution Error…………………………………………………………. 18 Fischoff’s Hindsight Bias………………………………………………………….. 19 Hedonic Relevance Bias………………………………………………………….... 19 Optimism Bias……………………………………………………………………... 20 Defensive Attribution Theory…………………………………………………….... 52

DEJOY’S MODEL OF WORKPLACE SAFETY MANAGEMENT………………... 20

SUBJECTIVITY IN ATTRIBUTION……………………………………………….... 22

Internals and Externals…………………………………………………………….. 22 Patients of Psychiatric Nurses……………………………………………………... 24 Witnesses and Victim…………………………………………………………….... 25 Attribution Asymmetries………………………………………………………….. 26 Culture Bias……………………………………………………………………….. 27 Socioeconomic Status……………………………………………………………... 28 Hierarchal Status…………………………………………………………………... 28 Occupation Type…………………………………………………………………... 29

FACTORS RELATED TO CAUSAL ATTRIBUTIONS…………………………….. 30

Emotions…………………………………………………………………………... 30 Learned Helplessness…………………………………………………………….... 31 Covariation Data………………………………………………………………….... 32 Safety Climate and Communication……………………………………………….. 33


Hierarchical Position, Gender and Accident Severity……………………………... 33 Previous Accident Experience……………………………………………………... 35 Job Satisfaction…………………………………………………………………….. 35 Perceived controllability, danger, risktaking and desirability…………………….. 36 Age…………………………………………………………………………………. 36

ATTRIBUTIONS FOR ACCIDENTS AND ASSOCIATED OUTCOMES…………. 37

Accusations………………………………………………………………………….37 Group Attributions and Impact on Performance…………………………………….37 Acts of Criminal Violence………………………………………………………….. 38 Causal Responsibility and Culpability……………………………………………... 39 PostCrash Symptomology…………………………………………………………. 39 Effort and Supervisory Response to Accidents…………………………………….. 40 Racially Biased Attributions……………………………………………………….. 41 AlcoholImpaired Driving…………………………………………………………. 41 Spontaneous Attributional Search…………………………………………………. 42 Crash Survivors…………………………………………………………………….. 42 Aggressive Driving Incidents………………………………………………………. 43 Teacher’s Attributions of Student Failure………………………………………….. 44 Student Attributions for Success/Failure in Mathematics………………………….. 44 Attribution Patterns of Unsafe Behaviour Incidents in Mining Enterprise……….... 45 Small Business Owner Attributions for InjuryRelated Work Absence…………….46 Nurses Causal Attributions for Severity DependentError………………………….47 Role of Causal Attributions in Accident Analysis and Safety Interventions………. 49

ANALYSIS OF ACCIDENTS AND IDENTIFICATION OF HUMAN ERROR…….49

Attribution Patterns among Victims, Coworkers and Supervisors………………….49 Blame, Victim, Offender Status and Pursuit of Revenge…………………………... 50 Consumer Response to Public Hospital Service Failure…………………………... 50

SUMMARY AND FUTURE CONSIDERATIONS………………………………….. 52

Themes in Literature………………………………………………………………. 52 Trends in Literature……………………………………………………………….. 54 Gaps in Literature………………………………………………………………….. 56

PROPOSED METHODOLOGY FOR FUTURE STUDIES…………………………. 58

Central and Ongoing Role of Researchers…………………………………………. 60 REFERENCES……………………………………………………………………….... 61 APPENDICES………………………………………………………………………….84


AN EXPLORATION OF ACCIDENT/FAILURE ATTRIBUTIONS AND THE POTENTIAL IMPLICATIONS FOR FUTURE RESEARCH IN OCCUPATIONAL

HEALTH PSYCHOLOGY WITH PSYCHIATRIC NURSES

Psychiatric Nurses and their Vulnerability to Occupational Accidents

Nurses’ contributions to the health care system are essential and immense. In

public surveys, the nursing profession tends to garner significant support and respondents

tend to view nurses as trustworthy (Health Canada, 2002), honest, and ethical (American

Nurses Association [ANA], 2010; 2014). Also inherent to the profession are a number of

hazards and stressors, most of which are unique to their specific duties. It follows that

nurses will likely also experience unique occupational health and illness related issues.

To offer some perspective, Health Canada (2013a) estimates that each year, more

than 16 million nursing hours are lost as a result of injury and illness, which represents

about 9000 fulltime positions. The Canadian Labour and Business Centre (CLBC)

(2002) estimated the cost of overtime, absenteeism, and replacement of nurses at $962

million to $1.5 billion annually. It reported that as many as 7.4% of all registered nurses

(RNs) are absent from work due to injury, illness, burnout or disability (CLBC, 2002) in

any given week. In addition, nursing absenteeism is 80% higher than the average of 47

other occupational groups (i.e., 8.1% in nursing and 4.5% for others). Health Canada

(2013b) found that LPNs (licensed practical nurses) and RPNs (registered psychiatric

nurses) appear to have even higher rates, although exact numbers are unknown.

Researchers have sought to understand the reasons behind these statistics (Hackett

& Bycio, 1996; Rajbhandary & Basu, 2010; Rauhala et al., 2007). For example, direct

patient threats (Mckenna, Poole, Smith, Coverdale & Gate, 2003), assaults (Arnetz et al.,


2014) as well as physical and emotional abuse (International Council of Nurses, 2004)

appear to be common in nursing. A Canadian survey by Henderson (2003) examined four

clinical settings: maternity, community, emergency and mental health and found that 50%

of frontline nurses were verbally abused and 22% reported physical abuse in a 12month

period. These statistics appear to be consistent with previously published data. Poster

(1996) found that 45% of Canadian and 61% of United Kingdom (UK) nurses had been

assaulted at work by both patients and patients’ relatives. Nurses also experience stressors

and hazards unique to their scope of practice.

In mental healthcare, there are a number of recurring problems and challenges

such as bullying, violence, aggression, role conflict and having to control patients

(Mctiernan & McDonald, 2015; Muthuvenkatachalam, Chetana, Sandhya & Sonika,

2014). In fact, violence and verbal abuse appears to have become “routine” for

psychiatric and emergency nurses. Statistics Canada (2005) reported that RPNs are

particularly at risk with 47% reporting physical assault and 72% reporting emotional

abuse. Male nurses report emotional abuse more often (55%) than female nurses (46%).

This is believed to be the result of the roles assigned or expected of male nurses with

aggressive patients (Statistics Canada, 2005). Common to both genders are high rates of

assaults, which have been shown to impact RPNs in the form of PostTraumatic Stress

Disorder (PTSD) (Jacobowitz, 2013).

Even the perceived risk of exposure to trauma can result in work stress. A study

by Ito, Eisen, Sederer, Yamanda and Tachimori (2001) investigated the intention of

psychiatric nurses to leave in relation to their perceived risk of assault. The National


Institute for Occupational Safety and Health (NIOSH) job stress questionnaire was used

to assess the perceived risk of assault, job satisfaction, supervisory support and intentions

to leave. Ito el al., (2001) found that the perceived risk of assault as well as insufficient

job satisfaction and support from supervisors were all related to nurses’ intentions to

leave their job.

Moreover, it has been long recognized that mental health is strongly linked with

physical health (Bartholomew, Morrison & Ciccolo, 2005; Peluso & Silveira Guerra de

Andrade, 2005). According to Berrios, Joffres and Wang (2015), nurses are more prone

to distress and subsequent illness relative to other Canadian workers. This is often

reported in studies that have investigated the relationship between nurse stress levels and

related psychosomatic illness (Humaida, 2012; Kane, 2009; Tangestani, Khalafi &

Esmaeily, 2014). In fact, nurses are at an increased risk of depression, absenteeism and

disability claims, which can lead to compromised patient care (Berrios et al., 2015).

Nurses often perceive risk in their workplace and express insufficient support

(e.g., organizational or managerial) in addressing these issues. This not only has

implications for health and safety, but also for recruitment and retention (Health Canada,

2007; 2013c).

Factors Contributing to Injury, Absenteeism and Emotional Exhaustion

Workers in the health industry are vulnerable to lost time due to injury and illness

(see appendix 1) (Association of Workers’ Compensation Boards of Canada [AWCBC],

2013). In the nursing profession, a number of working conditions seem to contribute to

the likelihood of occupational accidents.


Compared to other healthcare professionals, nurses and nurse assistants

experience a significantly higher number of injuries (see appendix 2 & 3) (Centre for

Disease Control [CDC], 2015). Musculoskeletal injuries (Bruce. Sale, Shamian,

O’BrienPallas & Thompson, 2002; Shamian, Kerr, Laschinger & Thompson, 2002),

needle stick injuries (Clarke, Rockett, Sloanne & Aiken, 2002) and back strain injuries

(WorkSafe BC, 2012) are particularly prevalent in nursing. In fact, compared to all other

occupational groups investigated in British Columbia (see appendix 4); workers in

healthcare were the most likely to suffer from back strain injuries (WorkSafe BC, 2012).

In fact, a cross sectional study by Byrns, Jin and Parchis (2004) assessed back

pain disabilities in a sample of 270 RNs and this sample reported that back pain

disabilities were associated with more years worked, frequent lifting and low social

support. Similarly, Lipscomb, Trinkoff, GeigerBrown and Brady (2002) found that a

greater number of hours worked predicted musculoskeletal disorders of the shoulder,

neck and back. Overexertion appears to be a common issue for nurses (see appendix 5),

which has been associated with lifting patients (Bureau of Labor Statistics, 2006).

According to Karasek, Baker, Marxer, Ahlbom and Theorell, (1981), high job

demands and low control over the job may also elicit health problems and the most

satisfied/healthy workers are said to be those who have a job with high demand and high

control. Unfortunately, nursing is reported as a high demands/low control profession

(Johnston, Jones, Charles, Mccann & Mckee, 2013). This may in turn help explain

burnout, emotional/physical exhaustion, higher stress levels, and injuries.


In Bruce, Sale, Shamia, O’BrienPallas and Thompson’s (2002) study, workload

was the strongest determinant of high injury rates among RNs. A lack of equipment,

crowded spaces, and poor ergonomics in the work setting were additional contributors.

Similarly, O’BrienPallas et al., (2004) found a relationship between losttime claims and

the amount of overtime worked. This relationship also appears to be true with

occupational accidents. That is, more overtime appeared to predict accidents such as

needlestick injuries of the hands/fingers (Özarslan, 2011).

Mental health appeared to be a strong predictor of occupational accidents

experienced by nurses in Suzuki et al’s (2004) study. The authors measured mental health

status with the Japanese version of the General Health Questionnaire (GHQ12). They

assessed participant’s sleep, occupational accidents, and shift work. The authors found

that for each type of accident (e.g., drugadministration errors, incorrect operation of

medical equipment, errors in patient identification and needlestick injuries), medical

errors were significantly higher among nurses who were in the mentally in poor health

group than the mentally in good health group. The CNA (2004) also found that nurses

who report higher mental health status tend to also report better working relationships

with physicians. In addition, Lipscomb et al., (2002) found that mental health has been

positively associated with job satisfaction and negatively associated with emotional

exhaustion.

The term burnout has been used in the nursing literature to describe workrelated

exhaustion (Rudman & Gustavsson, 2012; Sprinks, 2015; Weber & JackelReinhard,

2000). While other definitions exist, burnout was defined by McCarthy (1985) as a


“syndrome involving progressive physical and emotional exhaustion, the development of

negative job attitudes and perceptions and loss of empathic concern for patients”

(McCarthy, 1985, p.305). According to Melchior, Bours, Schmitz and Wittich’s (1997)

metaanalysis, three risk factors are associated with burnout: the patient group with whom

the nurse works (e.g., suicidal or aggressive patients), the exchange process between

nurses and patients (e.g., verbal abuse by patients) and the unrealistic expectations for the

patients’ potential for rehabilitation.

Mann and Cowburn (2005) discussed the “emotional labour” required of nurses,

which has been understood by Brotherridge and Lee (2003) as the effort they expend to

regulate their emotions and meet the expectations of their roles. They found that nurses

engage in “surface acting”, where they simulate an emotion, and “deep acting” during

which they try to actually experience the emotion. Results from questionnaires revealed

that surface acting was a more important predictor of emotional labour than deep acting.

Emotional labour was positively correlated with interaction stress (i.e., between patient

and nurse) and daily stress levels. The authors reported a relationship between the

intensity of interactions and the number of emotions experienced. Emotional labour was

also associated with the intensity of interactions. Related to this, Kitts (2013) reported

that helping individuals cope with illness could result in compassion fatigue and

according to the CNA (2004), emotional exhaustion is especially prevalent among RPNs.

These challenges, along with others reported by RPNs will be presented next from the

results of a qualitative study.


Jackson and Morrissette (2014) used a qualitative phenomenological methodology

to explore the experiences of 10 Canadian RPNs by way of semistructured interviews.

Five themes were drawn from this research.

Theme 1 of Jackson and Morrissette’s (2014) study was the perception of

psychiatric nursing. RPNs felt their professionlacked identity. Similarly, studying

experienced psychiatric nurses, Humble and Cross (2010) found that those within this

nursing specialty felt misunderstood and underappreciated when they compared

themselves to other nonpsychiatric nurses and other professionals. It was also felt that

psychiatric nurses carried the stigma of their patients. That is, they felt prone to being

judged in a similar manner as their patients.

Theme 2 of Jackson and Morrissette’s (2014) study related to patient aggression

(e.g., emotional, physical, and sexual), which has been documented by other researchers

(Lowe el al., 2003; Myon & Robinson, 2012). The result can be a reluctance to get in

harm’s way, which can lead to poorer group dynamics in the workplace (e.g., less

cohesion, collaboration). Risk management and personal safety was of particular concern

for nurses with young families and those contemplating pregnancy. Aggressive patients

were described as more compliant with male nursing staff compared to females, who

experienced higher levels of patient resistance.

Theme 3 of Jackson and Morrissette’s (2014) study related to patient family

involvement. Not surprisingly, nurses reported more fatigue when they were required to

deal with confrontational families. In addition, nursepatient family disagreements (e.g.,

questioning interventions) created a variety of challenges such as altering effective


intervention modalities unnecessarily. Psychiatric nurses often felt marginalized and

experienced a sense of powerlessness with patients and patient families. They also

described being triangulated between patient families, patients, and physicians due to the

nature of their work.

Theme 4 of Jackson and Morrissette’s (2014) study was related to the

nursephysician relationship. Participants reported that contact with physicians could

often be positive. However, some nurses reported that their working relationships

required a great deal of effort and the duties imposed by physicians could lead to job

ambiguity. Also, the attitude that a physician may hold (e.g., superiority) or their

indecisiveness regarding treatment could lead to frustration. Effective nursephysician

relationships seem to be enhanced when nurses held their work position longer, perceived

greater autonomy, and felt empowered (CNA, 2004).

The last theme of Jackson and Morrissette’s (2014) study was the sense of

responsibility. Relevant in this context is that some psychiatric nurses felt they had

insufficient medical training. Others believed counseling was an aspect of nursing that

required further attention since they did not feel their other duties allowed them enough

time to listen to their patients.

As previously discussed, nurses and perhaps psychiatric nurses in particular, face

a number of challenges in performing their work. Because these challenges may

predispose members of the profession to accidents and injuries (AWCBC, 2013) it may

be beneficial to understand how nurses interpret these events. In fact, Dejoy (1994)


argued that the interpretation of accidents could help guide remedial actions to prevent

accidents from recurring.

With this in mind, researchers have found attribution theory (AT) to be a useful

framework for exploratory and descriptive studies (Gyekye, 2003) including those related

to accident interpretation. Given the putative relationship that exists between attributions

and future behaviour (Gyekye, 2010), AT appears to hold the promise of contributing to a

better understanding of occupational accidents.

What is Attribution Theory (AT)?

Humans have a long history of attempting to explain events, their behaviour, as

well as the behaviour of others. In the social sciences, this phenomenon has been referred

to as attribution, defined by Weary, Stanley & Harvey (1989) as “an inference about why

an event occurred, about a person’s dispositions (i.e., a person’s inherent tendencies or

inclinations) or other psychological states” (Weary et al., 1989, p.2). Attribution theory

(AT) attempts to understand how people assign causality to behaviour with the intention

of offering a better understanding of future behavior (Gyekye, 2010). The theory

highlights that our attributions are based on both individual and situational factors.

AT appears to originate from the work of Heider (1944) who believed that people

explain behaviour informally. He introduced the term naïve psychology emphasizing that

we attempt to understand our physical and social world as we behave as “naïve

psychologists” (Gonçalves, da Silva, Lima & Meliá, 2008). Heider also believed there

was a tendency for people to attribute behaviour to dispositional factors (e.g., individual)

rather than situational factors (e.g., physical or social environment). The theory has since


attracted considerable interest and there are, in fact, over 5000 published journal articles

containing the word attribution in their title (Petri & Govern, 2013).

Based in part on the work of Jones et al., (1972), Petri and Govern (2013)

explained that AT rests on three basic assumptions. First, it assumes that people “attempt

to determine the causes of both their behaviour and that of others” (Petri & Govern, 2013,

p.304). Second, the “assignment of causes to behaviour is not done randomly; that is,

rules exist that help explain our conclusions about the causes of behaviour” (Petri &

Govern, 2013, p.304). Finally, “the causes attributed to particular behaviours will

influence subsequent emotional and nonemotional behaviours” (Petri & Govern, 2013,

p.304). Once an attribution is made, it influences the attributor’s subsequent behaviour

(Petri & Govern, 2013).

There are other contributors to existing theories of attribution. Jones and Davis

(1965) agreed with Heider (1944) on the idea of dispositional preference and offered

additional insights on such with a correspondent inference theory. They theorized that

individuals look for a correspondence between the observed behaviour and the inferred

intent of that behaviour. In short, observers seek to understand the choice an individual

has (i.e., a choice made among multiple alternatives), the social desirability of the

behavior (i.e., behaviour that most likely meets the approval of most people), and the

noncommon effect (i.e., if the behaviour of others have rare/uncommon effects that are

unique to that particular circumstance, then observers infer an underlying attribution as to

why the person engaged in that behaviour).


Kelley (1967, 1971, 1973) viewed attributions on the basis of covariation between

causes and effects across the dimensions of distinctiveness, consistency and consensus.

He explained that attributions are based on past behaviours and that distinctiveness (i.e.,

the unique nature of present behaviour compared to previous behaviour), consistency

(i.e., frequency that an individual engages in a particular behaviour) and consensus (i.e.,

how other people would respond in the same situation) are used in the attribution process.

Weiner (1985; 2010) expanded on the work of previous contributors such as

Heider, (1944) and Rotter, (1966) for past success and failure to better understand how

attributions can influence emotions, the expectation of future success/failure and future

behaviour. He offered that attributions are determined by the degree to which behaviours

are perceived as outcomes of internal versus external, stable versus unstable and

controllable versus uncontrollable factors. To demonstrate Weiner’s (1985; 2010) work,

Petri and Govern (2013) presented an abbreviated model in their book: Motivation:

Theory, Research and Application (see appendix 6). The model was initially created to

better understand achievement motivation but was then expanded to a variety of other

phenomena and has been used to explain the behaviour of self and others. It highlights

four elements in the interpretation of achievementrelated outcomes (i.e., ability, task

difficulty, effort and luck) (see appendix 6). In reference to Weiner’s work, Petri &

Govern (2013) explained Weiner’s AT approach when attributing to these elements.

More specifically, previous success/failure tends to lead to our attribution of ability.

Second, to determine effort, we tend to evaluate how much is invested in a task. Third, to

determine task difficulty, the tendency is to engage in social comparison. Finally, luck is


most often ascribed when there is no perceived control in the outcome. These elements

vary along three causal dimensions: locus of control, stability and controllability.

Locus of control is the first causal dimension and refers to whether an outcome

results from circumstances internal or external to the individual (Rotter, 1966). For

example, ability and effort are internal to the individual, or based on individual

dispositions (see appendix 6). However, outcomes that involve task difficulty or

happenstance are situational in nature and thus external to an individual.

Behaviour/outcome can thus be attributed to dispositional/internal factors or external

factors such as the social situation or other involved individuals.

The stability dimension speaks to the extent to which the cause of a particular

outcome is likely to change in the future (Martinko, 1995). If change is unlikely, events

are believed to be stable (e.g., ability and task difficulty) whereas if change is likely, it is

deemed unstable (e.g., effort and happenstance).

The last dimension is controllability, which estimates the degree to which some

causes are controllable or uncontrollable by oneself or others (Weiner, 1979). For

example, effort (e.g., individual effort) and task difficulty (e.g., others making a task

more or less difficult) are controllable when writing a test (i.e., controllable factors). In

that example, ability and luck are not controllable. According to Weiner, (1985; 2010) an

attribution is a systematic process (see appendix 6).


Attribution Biases

Evidently, attributions are not always accurate and much of human

decisionmaking is vulnerable to biases and errors. Four betterknown biases are

presented here.

The selfserving bias is the tendency to take credit for success and to avoid

responsibility for failure (Shepperd, Malone & Sweeny, 2008). The false consensus effect

can be understood as the tendency to believe that others think and act in a manner similar

to ourselves (Mullen et al., 1985). The actorobserver bias is the tendency of an observer

to attribute internal factors to an actor but to attribute the opposite when in the role of the

actor (Malle, 2006). Finally, and related to the actorobserver bias, is the fundamental

attribution error (FAE). Specifically, the FAE focuses on attributions made by the

observer. It states that individuals tend to underestimate the influence of situational

causes while overestimating stableinternal characteristics for the behaviour of others

(Ross, 1977). There are four other biases presented below that are less well known but

also described in the literature. They are, the ultimate attribution error, the hindsight bias,

the hedonic relevance bias, and the optimism bias.

Pettigrew (1979) proposed the ultimate attribution error, which is an extension of

the fundamental attribution error. He defined it as “a systematic patterning of intergroup

misattributions shaped in part by prejudice” (Pettigrew, 1979, p.464). Hewstone’s (1990)

research expanded on this and found (1) more internal attributions for positive acts and

less internal attributions for negative acts by ingroup members and the opposite for

outgroup members; (2) more frequent attributions for a lack of ability for outgroup than


ingroup failure and greater outgroup successes that are attributed to luck, high effort

and ease of task; (3) groupserving attributions vary across intergroup situations. The

ultimate attribution error finds applicability in various contexts. For instance, Hewstone

and Ward (1985) found that ethnocentrism had influenced attributions for ingroup and

outgroup members. Additionally, group attributions may be stronger when groups have

histories of intense conflict and possess negative stereotypes (e.g., about minority groups)

(Hewstone, 1990).

For his part, Fischhoff (1975) offered the hindsight bias. Here, observers distort

their perceptions of the uncertainties that face decisionmakers because they tend to

overestimate the degree to which others can foresee accidents (Fischhoff, 1975; Karlovac

& Darley, 1988). This phenomenon has been referred to as the “knew it all along effect”

(Roese & Vohs, 2012, p.1).

Martinko, Douglas and Harvey (2006) referred to the hedonic relevance bias in

their review of the literature, which has been characterized as the personal benefits

derived from outcome or behaviour (Martinko, 2002). Specifically, it is an observer’s

tendency to attribute the behaviour of another to negative internal factors rather than

situational factors when that person’s behaviour has affective consequences to the

observer (Jones & Davis, 1965). This was demonstrated in Dossett and Greenberg’s

(1981) study that investigated supervisors who were involved in the goal setting

processes of subordinate workers. As supervisors were more involved, there was a

tendency to make more favorable attributions towards subordinates with successful

performances (e.g., high ability and effort) and more unfavorable attributions with


subordinate failures (e.g., low ability and effort), as negative performances were a poor

reflection of the supervisors. This phenomenon potentially impairs the observer’s ability

to effectively evaluate employees, implement training, and make selection decisions

(Martinko, et al., 2006).

Lastly, there is optimism bias, which Caponecchia (2010) explained is the

tendency to think that negative events are less likely to happen to us than to peers. One

hundred and five postgraduate students and university employees were assessed via

questionnaires and optimism bias was found for several events including the likelihood of

suffering/injury. Thus, it appears that individuals believe hazardous events are less likely

to happen to them than to others with the same job.

There appears to be a lack of research related to attribution biases and their

application to nursing. Some researchers spoke of the negative attitudes and beliefs

nurses had about obese patients (Lee & Calamaro, 2012; Waller; LupferJohnson, 2012).

However, there appears to be a lack of research that has investigated accidentrelated

biases or lack thereof in nurses. More research is needed here as this may have

implications for prevention. The next section will introduce a model that incorporates the

attributions and biases discussed thus far.

Dejoy’s Attribution Model in the Context of Occupational Health and Safety

Dejoy (1994), proposed an “Attribution Theory Analysis and Model” related to

Workplace Safety Management (see appendix 7). He explained that attributions of

safetyrelated events would strongly influence the actions taken to correct hazards and/or

prevent future injuries. Referring to the work of Pittman and D'Agostino (1985) on


motivation and attribution, Dejoy (1994) explained that ambiguous situations increase the

chance of attribution errors and biases. He also proposed a model of attribution processes

regarding safety management, which incorporated components of Green and Mitchell’s

(1979) model of leadermember interaction and Ford’s (1985) model of corporate

performance. The model includes three phases that evaluate the cause of an

accident/event (see appendix 7). This includes decisionmaker characteristics,

safetyrelated events, and organizational policies and constraints.

The first step of Dejoy’s (1994) model is Informational Analysis where the

observer determines whether the event or outcome was caused by the worker

(person/actor), the task (entity), or by some set of circumstances related to the event

(context). Informational analysis is dependent on distinctiveness, consistency and

consensus (i.e., Kelley’s covariation model). Causal schemata and outcome severity can

also play a role (Dejoy, 1994). A schema refers to processing information from

experience or from explicit or implicit cultural norms. It is influenced by prior knowledge

rather than realtime data (Dejoy, 1994). Second, a causal attribution is made according

to Weiner’s attribution model (Weiner 1985; 2010). Finally, corrective actions are taken,

subject to a number of factors such as attribution biases (Deioy, 1994). The model also

demonstrates that decisionmaker characteristics and organizational policies and

constraints act as moderators, ultimately determining how the causal inference is derived.

The model emphasizes that attributions in safety management are strongly related to the

remedial actions taken by organizations (e.g., correction of hazards and/or prevention of

future injuries) and that safety events are complex (Deioy, 1994).


Related to nursing, there are a variety of models that have sought to improve the

health and safety climate of nurses. These include models related to leadership (Barling,

Kelloway, Loughlin, 2002), workplace bullying (Hutchinson, Jackson, Wilkes & Vickers,

2008) and models related to ensuring safety and quality care of psychiatric patients

(Gabrovec & Lobnikar, 2014). In the latter, Gabrovec and Lobnikar (2014) found their

model to be useful in health and safety training and saw noticeable improvements in

nurses in areas such as assertiveness, fear management and helplessness. Given that

Dejoy’s (1994) model emphasized the importance of attributions in guiding remedial

action, researchers may find value in applying a similar model to better understand the

attributions of nurses in relation to the occupational accidents they may have experienced.

Subjectivity in Attribution – Specific Pattern of Attribution in Individuals

Researchers have applied AT as a theoretical framework for decades (Brewin,

1984; Feather & Simon, 1969; Fitch, 1970). There appears to be a lack of research

investigating subjective patterns in nurses. Nevertheless, the studies presented in this

section support the notion that as individuals, we appear to have innate tendencies to

attribute in particular ways such as holding an external versus internal locus of control.

Internals tend to believe that specific outcomes are the result of their own actions and

efforts. In contrast, externals tend to believe that what happens to them is unrelated to

their behavior, or that it is beyond their control (Olpin & Hesson, 2010).

Davis and Davis’s (1971) study demonstrated this well. They conducted two

studies to examine how 40 internals and 40 externals attributed responsibility to

dispositional personal (internal) or external forces depending on failure or success


scenarios. In these studies, introductory psychology student subjects received positive or

negative feedback on a task where they were asked to predict another person’s attitude.

They were then asked questions that probed their internal (e.g., ability) and external (e.g.,

luck) attribution tendencies. Findings suggested that external attributions might emerge

for defensive purposes when failure is experienced. These individuals are categorized as

defensive externals. The authors of this study differentiated between those with a strong

external orientation (i.e., those who typically explain things with an external locus of

control) and defensive externals (i.e., those who attribute externally or forget for

defensive purposes in the face of failure). It appears that those who have a strong external

orientation have a lower tendency to resort to “forgetting” or denying as defensive

strategies since they attribute failure to impersonal forces (Davis & Davis, 1971). In both

studies, internals showed a greater tendency to blame themselves for failure than

externals. The two groups did not differ in how they attributed success.

Expanding on this work, Hyland and Cooper (1976) studied how internals and

externals attributed causes in a happy accident (i.e., an accident that resulted in something

positive). A hypothetical happy accident was presented to participants (56 psychology

students categorized by InternalExternal scores) whereby a chemist mixed chemicals

carelessly but made an important discovery. Internals perceived the scientist as more

responsible for the outcome than externals and those rated as moderates for the happy

accident. Externals were the least certain about why the outcome occurred. Reconciling

the findings of Davis and Davis (1971), Hyland and Cooper (1976) made the following

observations. It appeared externality was a method of preserving selfesteem during


failure. When externals judge others, they may provide a more objective view than

internals, but when judging themselves, taking credit for pleasant experience may

overwhelm the need to see things as externally caused (Hyland & Cooper, 1976).

In another study involving student participants, Stebbins and Stone (1977)

investigated attributions made according to various success or failure feedback conditions

on a communication test. A questionnaire and interview with selfreport satisfaction

measures were employed. This offered the 32 participants opportunities to attribute

responsibility following success or failure feedback to factors beyond personal control or

to various personal factors rated on a Likert scale. Participants with an external locus

were more likely to attribute outcomes to impersonal factors, whereas internals tended to

attribute to personal factors. Both groups favoured success conditions more than failure

and there was evidence of ego involvement. The results of this study suggest that

healthcare practitioners should encourage attribution processes that are consistent with a

client’s predispositions (Stebbins & Stone, 1977). For instance, for an external, the goal

might be to shift attributions more internally to encourage the assumption of

responsibility. In contrast, if the client’s attribution style (i.e., internal) is related to

negative psychological states such as low selfesteem or depression, the reverse pattern

may be needed.

In fact, a study by Peterson (1984) suggested that mental health nurses involved in

crisis interventions have recognized counterproductive attribution patterns in their

patients, which in turn was used to guide intervention. In her study, patient perceptions

were assumed as important in predicting subsequent patient behaviour. Patients attempted


to make sense of the distress or discomfort they were experiencing and in doing so, made

attributions that were counterproductive or detrimental to their health. For example,

patients who were recently divorced could attribute the dissolution of their marriage to

their exspouse, which was seen as a maladaptive coping technique by Peterson (1984).

Alternatively, attributing this to self and other external factors was seen as a more

effective coping method. In certain cases, it was suggested that the psychiatric nurse must

initiate the “reattribution process”, which assists the patient in exploring other reasons for

the crisis. It was suggested that finding external factors could help patients cope more

effectively with the crisis. Other researchers (Nickerson, Aderka, Bryant & Hofmann,

2013; Thompson, O’Donnell, Stafford, Nordfjaern & Berk, 2014) have proposed that

external attributions may lead to counterproductive ways of dealing with failure.

Nevertheless, internal attributions presume personal responsibility, which in certain

circumstances can be detrimental.

Furthermore, there appears to be discrepancies in the attributions of those

typically involved in occupational accidents. Kouabenan (1985) studied employees of a

telecommunications company who were 99 victims of, or 51 witnesses to, an

occupational accident and asked them to explain their causes. Witnesses attributed

causality to victims regardless of accident severity. Victims only blamed themselves in

mild accidents and pointed to bad luck more often than did witnesses. The more involved

a participant was in the accident, the more defensive the attribution. Using real accident

victims strengthened the study since attributions for an accident one reads/hears about is

often more neutral than when there is direct involvement (Kouabenan, 1985). This may


have methodological implications for research of this kind. It seems to be preferable to

draw from actual accident victim populations than to create entirely fictional vignettes,

which will be discussed at the end of this review.

Falbo, Wernick and Rowen (2001) spoke of attribution “asymmetries” (i.e.,

differences in attributions for success and failure). Twenty adults and onehundred and

three children aged 46 years were asked to explain the outcome for a fictional character

along the dimensions of task, ability, effort and luck. Findings revealed that adults

attributed asymmetrically such that success elicited more ability and effort attributions

whereas failure elicited more task difficulty and luck attributions (Falbo et al., 2001).

Asymmetries were found for 56 year old children but not for 4 year olds. In the older

children (56 year olds), success was explained by effort and ability whereas failure was

explained with task difficulty. In adults, luck was used slightly more to explain failure

than success but children did not attribute outcomes to luck whatsoever.

Developmentally, asymmetrical attributions seem to emerge early and may serve a

selfprotective function. With children over the age of 5 years, teachers can reinforce the

notion that success is the result of ability and effort and failure is due to insufficient

effort. This way, children learn to attribute in a manner similar to high achievers (Falbo et

al., 2001). The implications of Falbo et al’s (2001) study may also be important for those

educating/training newly hired nursing staff. For instance, trainers may want to encourage

highachieving attribution styles. The newly trained staff might then realize the

importance of their own abilities/efforts in fostering a strong health and safety culture,


which might subsequently lead to higher efforts to remediate current or future

shortcomings (e.g., occupational accidents, nearmisses).

Some societies tend to maintain a rather fatalistic conceptualization of accidents

(e.g., bad luck, misfortune or chance) and thus, there is value in understanding the

influence of beliefs, value systems, norms, common experiences, attitudes, roles, social

and technical practices on causal attribution. Kouabenan (1998) investigated if cultural

biases were present in the attributions of traffic accidents in the Ivory Coast. A variety of

questionnaires were used to identify beliefs in fate as well as risktaking and their

perceived relationship to the accidents. It was found that beliefs and social practices did

indeed influence the perception of risks as well as causal explanations for accidents. For

example, Kouabenan (1998) explained that in the Ivory Coast, death is rarely explained

as accidental especially for someone who is well known. Instead, the victim’s death is

most likely explained as a result of someone (or gods) harming them. By way of certain

rituals, members of the community attempt to determine who (or what) was responsible

for the outcome. Generally, fatalistic subjects seemed to have limited insight into risks

and accidents (Kouabenan, 1998). This led to higher risk behaviours for the following

reasons. The subjects believed the outcome was either inevitable or thought that by

respecting certain rituals, they were able to avoid the outcome. Fatalists attributed causes

that were outside drivers’ control as opposed to assigning driver responsibility due to a

perceived lack of control over events (Kouabenan, 1998).


Socioeconomic status’ (SES) influence on subjective attributions has also been

studied. Broderick (2001) recruited 60 seventh grade children to better understand this

contributing factor. Subjects were assigned to one of three block design task conditions:

solvable, unsolvable, or a control condition. Attributions for success did not differ across

socioeconomic strata (Broderick, 2001). However, in failure situations, lower SES

students were less prone to attribute the outcomes to unstable causes (e.g., effort and

luck) and instead attributed the outcomes to stable causes (e.g., ability and task

difficulty). Middle class children were more prone to attribute to unstable factors than

stable factors in response to failure. Whether other variables mediated the relationship

between SES and attribution was not explored in this study.

In an organizational context, Gibson and Schroeder (2003) examined the role of

hierarchal positions on blame or credit attributions. Negative attributions/blame can lead

to notable conflict whereas positive attributions/credit attributions can enhance

perceptions of trust, reduce future conflict and increase chances of reciprocations (Gibson

& Schroeder, 2003). In this study, 146 Masters of Business Administration (MBA)

students were given blame or credit vignettes and asked to attribute accordingly. For

failure events, individuals tended to assign more blame to those in higherlevel positions.

Moreover, blame assigned for failure surpassed the credit assigned for success. The

opposite was true for lowerlevel positions (Gibson & Schroeder, 2003). In flatter

hierarchal structures, where there is less oversight from supervisors, leaders attracted

higher levels of blame and credit than leaders in more hierarchical structures.

Additionally, groups were allocated less blame and credit than individuals. Throughout


the discussion of this study and prior research, sociologists and organizational theorists

have argued that social roles have been neglected in attributions. That is, individuals are

not only concerned with what the actor did but what they should have done. In this way,

it was argued that we not only act as “intuitive scientists” but also as “intuitive lawyers”

(Fincham & Jaspers, 1980; Hamilton & sanders, 1981).

It has been hypothesized that attribution patterns might vary according to

particular industries. According to the AWCBC (2013), the 5 most dangerous

occupations in Canada are: 1) construction, 2) fishing and trapping, 3) mining, quarrying

and oil wells, 4) logging and forestry as well as 5) transportation and storage. Based on

existing literature (Sims, Graves & Simpson, 1984), Gyekye (2003) suggested that the

higher the perceived likelihood of an occupational accident, the greater the fatalistic

orientation of workers (i.e., attribution of accident causality to workplace factors,

uncontrollable supernatural forces and nature). With mining known for its vulnerability to

occupational accidents (Marshall, 1996), Gyekye (2003) compared 33 workers in

Ghana’s mining industry with 88 workers in textile industries with the hypothesis that

miners’ attributions would be more contextualized, defensive, and externalized. Contrary

to expectation, no differences were found in the attributions of miners and nonminers.

Occupational type and accident frequency did not appear to influence attributions.


Factors related to Causal Attributions

A number of factors impact how an individual attributes accidents/failures. There

appears to be very few studies that have investigated such factors related to nurses and

specialties such as psychiatric nursing. Nevertheless, some of the main factors found

from this review are presented in the studies that follow.

Averill, Dewitt and Zimmer (1977) were interested in the role of emotion on

attribution. Emotions were conceptualized as biologically primitive unconscious reactions

and were expected to “excuse behaviour”. As such, an emotional attribution (i.e., an

attribution of an outcome to one’s own emotions) may lead individuals to feel less

responsible for the outcome (Averill et al., 1977). Emotions such as those related to fear

and surprise were induced in 48 university students and their relationship with failure or

success in a problemsolving task was assessed. Findings revealed that emotional

attributions were more likely following failure than success regardless of state of arousal

(i.e., positive or negative) (Averill et al.,1977). Success or failure was insufficient for the

attribution of emotion since appropriate cues (e.g., affectively charged stimuli such as

photos of nudes and corpses) also needed to be present. Selfattribution of emotion was

used most frequently with egoinvolved individuals (i.e., involvement of one’s

selfesteem in the performance of a task or in an object) who needed to “excuse”

behaviour (Averill et al., 1977).

More recently, Coleman (2013) studied human emotions in relation to the

ultimate attribution error. In this study, fear, anger, or neutral mood states were induced

in 420 undergraduate students. Participants were assigned to political teams and asked to


attribute good or bad behaviour in different political scenarios. Results confirmed

emotions did influence the ultimate attribution error. First, there was a tendency for

negative acts to be attributed to dispositional factors for outgroup members. The

opposite was true for ingroup members (i.e., negative acts were attributed to external

factors). Second, positive acts were attributed to situational factors for outgroup

members and vice versa for ingroup members (i.e., positive acts were attributed to

internal factors). Coleman (2013) identified that positive mood was associated with more

internal attributions for success and fewer internal attributions for failure. The opposite

tendency was noted for those in negative mood states.

Miller and Norman (1979) believed learned helplessness would be associated with

particular attribution styles. They proposed a revised model of AT as a result. In their

review of the literature, they determined that AT could influence a person’s expectation

and their performance in future tasks. Also, the attribution of noncontigent failure (i.e.,

failure not dependent on anything else) to ability/personal competence led to increased

learned helplessness, whereas attribution of these outcomes to situational factors or task

difficulty did not produce learned helplessness (Klein, FencilMorse & Selignman, 1976;

Tennen & Eller, 1977).

In another review of the literature, Zuckerman (1979) concluded that those with

high selfesteem had a greater need to make protective attributions following failure and

high achievers took more responsibility for success in higher reward/goal attainment

(Feather, 1969; Fitch, 1970; Kuiper, 1978). Related to this, Schlenker and Miller (1977)

studied group members (three or more people assigned to problem solving tasks) and


found that those who developed strong interpersonal bonds were less willing to take

credit for success or to blame others for failure. Also, externals tended to deny

responsibility for failure and to project blame onto others (Schlenker & Miller, 1977).

One of the few studies related to nursing made reference to Kelley’s covariation

model, whereby attributions are based on past behaviours. Mitchell and Wood (1980)

presented 2 samples of nursing supervisors (containing 23 participants respectively) with

hypothetical accidents in which distinctiveness, consistency and consensus determined

punitive action. The authors of this study did not specify which type of nurses

participated in this study. However, results showed that hypothetical accident victims

with poorer histories were identified by nursing supervisors as those who should receive

the most punishment and consensus, consistency as well as distinctiveness helped predict

causal attributions. Specifically, a poor history involves: 1) low distinctiveness (i.e.,

subordinate performed poorly on other types of tasks and poorly on the one in question)

2) high consistency (i.e., the subordinate has performed poorly on this type of task in the

past) and, 3) low consensus (i.e., no one else had difficulty with the task). The

seriousness of the accident led to more internal attributions to the worker, which caused

more frequent punitive responses by supervisors. In a similar study of nursing accidents,

Mitchell and Kalb (1981) found that supervisors assigned more internal attributions when

the outcome of unsafe behaviour was known, particularly if it involved negative

consequences to the victim.


Jeong (2009) also made reference to Kelley’s covariation model but focused on

the influence of distinctiveness information (i.e., the degree to which behaviour is unique)

on causal attributions. He examined 180 public responses to a corporation that caused an

oil spill using Weiner’s attribution model. Specifically, he investigated how

distinctiveness information affected public attributions about the accident and how these

lead to punitive opinions and behaviour toward the corporation. Two experimental

conditions were used: 1) a news article demonstrating high distinctiveness showing that

the corporation had done well in the past, 2) a low distinctiveness condition where the

company had performed poorly in the past, and 3) a control condition in which no

message was given. Distinctiveness information significantly influenced attributions

assigned to a corporation and subsequent punitive opinions towards the organization.

Particularly, low distinctiveness (previous bad performance) produced more internal

attributions, more damage to reputation and punitive opinions. On the other hand, high

distinctiveness and no information were negatively correlated.

In the organizational context, Hofmann and Stetzer (1998) demonstrated that

safety climate and communication could influence attribution processes and/or accident

interpretation. Respondents of this study were employees of a large utility company. Two

samples containing over a thousand workers were asked to provide safety climate and

communication ratings. They were given Occupational Safety and Health Administration

(OSHA) reports or accident vignettes pointing to either a worker’s fault or factors beyond

the worker’s control. This study highlighted that contextual factors can influence accident

attributions. When safety communication was high, both samples made more internal


attributions when the evidence in fact implicated the worker. Those who had poorer

safety communication made more external attributions when the evidence in fact

implicated the worker (Hofmann & Stetzer, 1998). However, when the evidence

implicated external causes, the attributions were external. Contrary to expectation, safety

communication did not mediate the relationship between safety climate and attributions

in either sample. Instead, Hoffman and Stetzer (1998) proposed that safety climate might

mediate the relationship between safety communication and attributions. Investigations

into the causes of negative events (e.g., industrial accidents) are therefore influenced by a

number of factors. Importantly, investigations are more often driven by what

investigators expect to find rather than other actual implicit causes (Hofman & Stetzer,

1998; Rasmussen, 1990).

Kouabenan, Medina, Gilibert and Bouzon (2001) investigated the role of

hierarchical position, gender, and accident severity on attributions. These authors

explored the attributions of 80 participants of an electrical production/distribution

company and a skilift company. Two studies were conducted using questionnaires and

accident analyses. The authors reported that internal attributions are more often assigned

to subordinate victims in organizations with greater hierarchal structures. Subordinates

who were at the same level as the victim were less likely to assign internal attributions.

Outgroup members or those at different hierarchal levels assigned more internal

attributions to those at other levels. As explained by the ultimate attribution error,

attributions for ingroup accidents were less internal for groupprotection purposes and

this tendency increased, as accidents were more severe. No significant gender differences


were found. The researchers concluded that testimonials might be of questionable value

in terms of the accuracy of information provided by those involved in accidents

(Kouabenan et al., 2001).

Having been previously involved in accidents (i.e., previous accident experience)

appears to be associated with the manner in which individuals will attribute accidents in

the future. Gonçalves, Silva, Lima and Meliá (2008) analyzed this relationship and how it

might influence a sample of 559 participants in an industrial organization and another

sample of 335 participants in a research and development organization. The authors

found work accident experience to be positively associated with external attributions.

Unsafe behaviours were inversely associated with internal attributions. They proposed

that training as well as accurate information (e.g., safety information, information among

workers) might lead to more healthy/productive attributions. That is, “a well informed

employee rarely attributes to one cause” (Gonçalves et al., 2008, p.999). Organizations

with stronger safety cultures (i.e., good safety training and communication) tend to have

more complex attributions and perhaps, more accurate ones (Gonçalves et al., 2008).

Gyekye and Salminen (2006) considered job satisfaction and its influence on

attributions of workplace accidents in industrial Ghanaian workplaces such as mines and

factories. Participants were 121 actual victims, 82 supervisors, and 117 coworkers

involved in accidents. In this study, satisfied workers assumed greater responsibility for

their failures. Dissatisfied supervisors attributed more externally (e.g., low wages, work

overload, pressure from management and fatigue) while satisfied supervisors made more

internal attributions (e.g., lack of adequate comprehension and ability/inexperience).


Satisfied workers seemed to have an internal attribution style, which may have a positive

influence on organizational safety culture. Specifically, Dejoy (1989) emphasized that

acknowledging relevancy to oneself in any safety or health initiative is key for its

success. More research is needed to see if this internal attribution style is also related to

job satisfaction in other occupational groups such as nurses.

Rickard (2014) looked at the influence of perceptions of risk such as

controllability, danger, recreational risktaking, and desirability of risk on causal

attributions. In this study, Rickard (2014) built on Walster’s (1966) notion of “defensive

attribution”, which is a selfprotective mechanism whereby an observer concludes that if

the actor had behaved differently, the negative outcome could have been avoided. Using

three national parks in the United States as the context, hypothetical visitor accidents

were presented for interpretation. Generally, participants (447 park visitors) made more

internal (i.e., characteristics of the victim) than external attributions (i.e., characteristics

of the park or management). When park risks were viewed as controllable, they were

more likely to attribute the cause of an accident to the victim. However, when similar

experiences were solicited from the participants’ lives, the author noted lower internal

attributions.

Age has been found to influence workplace performance attributions. Cox (2014)

asked 203 supervisors from various industries to attribute causality in a hypothetical

scenario where a subordinate performed poorly. Poor performance by older targets was

more often attributed to external and controllable causes by older raters. Younger raters

were more inclined to assign stable causes (i.e., task difficulty and ability) to older


targets. The next section will look more closely at the attributions given for different

types of accidents/failure and the associated outcomes of such.

Attributions and Associated Outcomes

Postaccident or failure attributions can influence outcomes in a productive or

counterproductive manner (e.g., organizational safety culture, health). There appears to

be a lack of studies related to nursing; however, one study will be presented in this

section. Generally speaking, researchers have investigated postaccident failure

attributions extensively.

Shaw and Breed (1970) considered the effects of accusations on the accused in

terms of attitudes and perceptions as well as its overall impact on small group

interaction/performance. Accusations, even when unjustified, have negative

consequences for the accused. In this study, the accused tended to have negative feelings

toward the accuser and other members of their group. As well, overall group performance

decreased in situations where someone was accused. Finally, those who witnessed

accusations tended to have more negative feelings toward the accused.

In another group context, Bazarova and Hancock (2012) examined attributions of

192 students divided into groups and how these can affect performance, communication,

procedural change and effort. The authors asked groups to work on a twostep task

(recommend meritbased bonuses for fictitious employees based on four characteristics)

where they received negative feedback. Researchers found mixed results in that the

attribution of failure to situational constraints improved communication among group

members and improved procedures. However, the attribution of failure to self or group


produced greater effort. In contrast, attributions to others resulted in decreased

communication and performance. The implications of this study are important in that

normally, external attributions are seen as counterproductive but this may not always be

the case in a group context. Specifically, attributing to a combination of internal and

external factors was related to better outcomes.

Attributions are important determinants of sanctions. Using AT, Felson and

Ribner (1981) examined acts of criminal violence in a sample of 226 incarcerated males

and their sanctions. The authors distinguished between excuses (i.e., “a denial of personal

causation”) (Felson & Ribner, 1981, p.137) and justifications, (i.e., “an attempt to align

oneself with some norm other than the one violated, or reason”) (Felson & Ribner, 1981,

p.137). The most common excuses used were accidents, drinking, drugs, and states of

mind while the most common justifications were selfdefense, victim wrongdoing,

conflict with the victim and helping someone else. Justifications were used more

frequently (50%) than excuses (18.7%) or other reasons (31%). The authors referred to

Buss’s (1978) conceptual critique of AT in that attribution theorists have not placed

enough emphasis on distinguishing between cause and reason in the literature. Here,

offenders rationalized their homicides and assaults by way of reasons (i.e., justifications)

more frequently than causes (i.e., excuses). With this in mind, Buss’s (1978) critique does

seem to hold some validity. While cause and reason might be considered synonymous, it

appears that both reasons (i.e., a statement offered in explanation or justification) and/or

causes (i.e., someone or something that produces an effect) are used to infer why an event

occurred and that these terms could be further distinguished in AT.


Brewin (1984) opined there were two dimensions of blame in the attribution

literature: causal responsibility (i.e., the individual acts in such a way to produce the

outcome) and culpability (i.e., a moral evaluation referring to whether a person deserves

blame for the outcome). In this study, 93 male industrial accident victims were recruited

from trauma clinics after injury then again after a return to work. The influence of

attributions on rehabilitation outcomes was examined. Questionnaires were used to assess

psychological and physical health, causal attributions, as well as culpability. Participants

who felt responsible for their accidents reported better mood after their return to work.

The findings suggest that a sense of regret or culpability may be related to positive

outcomes. It may be the case that a more expedient return to work represents a type of

restitution on the part of the worker.

Related to this and with a focus on return to work, Thompson, O’Donnell,

Stafford, Nordjaern and Berk (2014) hypothesized that perceptions and attributions would

influence rates of postcrash depressive symptomology and recovery. The client record

data and outcome surveys of 303 participants were analyzed. Workers who did not

selfattribute responsibility were three times more likely to experience depression and

those who were depressed were 3.5 times less likely to return to work. This is consistent

with Nickerson el al., (2013) who found that those who attributed externally in motor

vehicle accidents exhibited higher rates of PostTraumatic Stress Disorder (PTSD) than

those who assumed responsibility. While contradictory evidence has been published in

terms to assuming full responsibility for accidents (Miller & Norman, 1979; Peterson,

1984), it appears that psychological recovery is associated with attribution patterns. In


addition, given that nursing absenteeism rates are significantly higher than the Canadian

average (CLBC, 2002) and these rates may be related to accidents experienced in the

workforce, researchers may wish to investigate whether nursing attributions might also

influence returntowork in the same manner as Thompson et al’s (2014) and Nickerson

et al’s (2013) study have indicated. Perhaps there may need to be a specific focus on

nurses frequently exposed to traumatic events (e.g., patient violence) such as psychiatric

nurses (Stevenson, Jack, O’Mara & Legris, 2015).

Lacroix and Dejoy (1989) considered the effect of attributions on effort and

supervisory response to workplace accidents. One hundred and sixtytwo business

students were asked to read industrial accident reports, which varied in terms of causal

locus, stabilityinstability as well as severity. They were asked to assume the role of the

supervisor in assessing the accidents. The more internal the cause, the more responsibility

and workerdirected corrective actions were prescribed to workers. Subjects seemed to

“overattribute” effort in that it was rated as important even when not mentioned in the

accident reports. The author speculated that this could be explained by attribution biases

(e.g., the fundamental attribution error) in that the tendency for observers is to explain the

behaviour of others with stableinternal factors and to underestimate situational factors.

In contrast, there is a tendency to attribute our own behaviour to situational factors.

Moreover, workerdirected remedies were deemed more appropriate when stability

factors (i.e., ability and task difficulty) were involved. The more stable the cause, the less

optimistic future safety performance was believed to be. Counter to prediction, accident


severity did not significantly affect attributions. Expectations for safety performance were

most optimistic when an external cause was identified.

In Orpen’s (1981) study, it was demonstrated that performance attributions could

be subject to discrimination. The author examined how 136 managers in South Africa

evaluated worker performance (White and Black race). Although discrimination had been

abolished a year prior to the research, supervisors used racially biased attributions for

performance. They more frequently attributed the success of Whites to internal factors

(e.g., effort and ability) and the success of Blacks to external factors (e.g., luck or an

“easy job”). The researcher highlighted how attributions can impact the careers of

minority group members and result in unfair negative consequences. This study was

limited in that the design was based on descriptive scenarios developed by the author to

resemble attributions made in a typical supervisor setting. Thus, while these scenarios

might be perceived as possible, they were not real accidents.

With alcoholimpaired driving, there appears to be some patterns in the way

observers ascribe responsibility to those who drink and drive. Dejoy (1989) authored a

review of the literature on this topic and offered a summary. The perceived seriousness of

alcohol impaired driving was driven primarily by the consequence of the behaviour rather

than the behaviour itself (i.e., minor consequences result in minor sanctions and vice

versa) (Dejoy, 1987a; Dejoy, 1985). In support of Defensive Attribution Theory (DAT),

observers who detected a degree of situational or personal relevancy in the behaviour of

others more often engaged in selfprotection motives (Walster, 1966). That is, people

tend to seek differences between themselves (observer) and the actor (perpetrator), as this


seems to decrease the concern that negative events might also happen to them. Thus,

internal attributions are made to actors. Alcoholimpaired driving was only perceived

serious when there was a clear adverse consequence such as personal injury or property

damage (Dejoy, 1984 Dejoy, 1985) and alcohol consumption prior to driving was not

blameworthy unless it exceeded legal limits (Dejoy, 1987a).

A year afterward, Dejoy (1990) investigated spontaneous attributional search (i.e.,

immediate selfquestioning) following nearmiss and lossproducing traffic accidents.

Ninetysix participants were given written descriptions of motor vehicle accidents and

were asked to list questions they would ask themselves following an accident that

differed in terms of outcome, severity and fault. Contrary to prediction, serious

consequences produced more interest in damage control (i.e., concern about thinking

about appropriate actions and likely consequences) than causal attribution analysis (i.e.,

trying to explain why the event occurred). Nearmisses produced less emotional response

and less selfquestioning than more serious outcomes but there was an acknowledgement

that the result might not be as benign if the nearmiss were to happen again. There was

evidence of selfserving biases and stricter penalty assignments for serious accidents than

nearmisses. Finally, subjects made more internal attributions of causality when the actor

in the written description was believed to be at fault and more stable attributions were

assigned with more serious outcomes.

In another study involving car accidents, Stewart (2005) studied the attributions of

321 crash survivors (i.e., drivers, road/weather conditions or themselves) using defensive

attribution theory (DAT) and actorobserver bias. Consistent with DAT, surveys showed


that greater accident severity predicted fewer internal attributions, fewer attributions to

weather/road conditions and greater blame assigned to other drivers by accident victims.

Those involved in less severe crashes assigned approximately the same amount of

responsibility to self as others. Passengers attributed in the same manner. However, those

in nonsevere crashes assigned more responsibility to others and to weather. Passengers

in severe crashes attributed more responsibility to drivers than to weather and road

conditions. In addition, the results provided some evidence of an actorobserver bias and

the fundamental attribution error. Regardless of crash severity, when crash survivors

accepted responsibility for crashes (i.e., as actors); they also ascribed more responsibility

to weather and road conditions. This was not the case when they strictly assigned the

cause of the crash to another driver (i.e., a focus on stable, internal characteristics) as

observers. Finally, those who accepted more responsibility coped better with the crash

than those who blamed the accident on other factors.

Focusing on aggressive driving incidents, Lennon, Watson, Arlidge and Fraine

(2011) found the actorobserver bias to be a useful framework in their study to explore

perpetrator or victim attributions. A convenience sample of 193 drivers was assigned to

perpetrator (or instigator) or victim groups. Participants completed the Aggression

Questionnaire and Driving Anger Scale and responded to driver aggression scenarios.

Compared to perpetrators, victims more often attributed the cause of driver aggression to

instigators’ driving skills. For their part, perpetrators assigned external temporary factors

(e.g., lapses in judgment or errors) as the cause of the accident suggesting some

selfawareness while minimizing outcome severity. Contrary to expectation, perpetrators


rated victim emotional impact higher than victims themselves. The fact that perpetrators

tended to attribute to internalunstable factors was seen as a positive outcome.

Perpetrators perceived their behaviour as modifiable, which would bode well for

intervention.

In the educational setting, Georgiou, Christou, Starvrinides and Panaoura (2002)

investigated 277 teachers’ attributions of student school failure and teacher behaviour

towards a failing students. Using a structural equation model, the authors concluded that

teachers behaved more empathetically and with less anger when they attributed students’

low achievement to insufficient ability. However, in contrast to prior research, this study

showed that teachers expressed more anger when attributing low achievement to

inadequate effort. Anger was inversely related to wanting to help a student improve (i.e.,

teacher giving up on student) (Georgiou et al., 2002). Teachers with higher selfefficacy

were more willing to accept responsibility for student failures, see it as a healthy

challenge and perhaps provide more attention to the student’s educational needs

(Georgiou et al., 2002).

College students seem to hold particular attribution styles that relate to their

academic performance. CortésSuárez and Sandiford (2008) used openended attribution

statements using the Causal Dimension Scale and examined attributions for success or

failure in 410 college Algebra students. Those who passed the test attributed more

internally to stable factors and to causes within their control. In contrast, the failing group

attributed more externally, to unstable factors, to external controllability and to things

beyond their control. A statistically significant difference between attribution statements


made by the passing and failing group was found. The passing group attributed

performance to effort and ability more often than the failure group who tended to

attribute to effort, ability, and task difficulty.

In another study related to student’s academic success or failure, Maidinsah,

Embong, A., Wahab & Z., Wahab, (2014) evaluated the causal attributions by 482

students regarding their performance on a mathematics test. High and low achievers were

recruited and given a questionnaire related to AT. The attributions were ability, effort,

question difficulty and environment. Most frequently, students identified effort as the

reason for success and failure in mathematics. This was followed by environment (e.g.,

lecturers/classroom atmosphere), question difficulty then ability. High achievers strongly

agreed that ability influenced success whereas low achievers strongly agreed that all

factors influenced their failures in mathematics (Maidinsah et al., 2014).

Focusing on the industrial context, Zhang, Gao & Yao, (2011) examined

attributional patterns of unsafe behaviour and incidents in a mining enterprise. Results

identified that managers attributed incidents to employees’ lack of knowledge,

employees’ lack of understanding of risk and lack of experience and skills. Team leaders

tended to believe that the key to preventing accidents was: 1) personal emergency

responding ability that can be strengthened through training, 2) behavior correction, and

3) reducing fatigue. Workers believed the key to accident prevention was 1) reducing

workload, 2) labor intensity, and 3) fatigue caused by working conditions. There were

significant differences in attributions among stakeholders of the organization. Some

consensus emerged in that work skills, individual emergency responding ability and labor


arrangement (e.g., breaks, rotations of workers, workload) were essential in preventing

accidents. In this enterprise, AT was a useful tool to help determine what the stakeholders

of an organization believed to be the causes of accidents and the type of changes

recommended for prevention.

On the basis of previous literature (Fabiano, Curro & Pastorino, 2004; Mendeloff

& Kagey, 1990 & Stevens, 1999), Hasle, Kines and Anderson (2009) argued that those

who work in small enterprises are at greater risk of injury than those in larger enterprises.

In Hasle et al’s (2009) study, the authors examined how small business owners attributed

accidents with a view of improving accident prevention. Twentytwo case studies of

injuryrelated work absence in construction and in metal processing were examined by

way of semistructured interviews and interpreted using thematic analysis. Onehalf of

the owners attributed the accidents to unforeseeable circumstances. In three cases,

respondents attributed the accidents to worker error as well as unforeseeable

circumstances. Two owners assumed partial responsibility. Small business owners

seemed ambivalent about safety, which suggested it was not a high priority area for them.

While the DAT may help explain these findings, there was a tendency for small business

owners to attribute accidents to unforeseen circumstances, thereby deflecting

accountability. Hasle el al., (2010) encouraged educating workers on attributions/biases

to assist organizations with accident prevention.

While this study suggested that smaller enterprises were more susceptible to

injury, the opposite appeared to be true in the hospital setting in a study by Babcock and

Fraser (2003) who examined rates of percutaneous injury (i.e., unintentional injury that


breaks the integrity of the skin) among different sized hospitals. It was found that the

annual rates of injury were higher among larger hospitals than smaller hospitals (i.e.,

larger hospitals had 22.5 injuries per 100 hospital beds yearly versus small hospitals that

had 9.5 injuries per 100 hospital beds yearly). Within the smaller hospitals investigated,

rural hospitals experienced more injuries as opposed to urban hospitals (i.e., average

annual rates of rural hospitals was 14.87 injuries per 100 hospital beds and for urban

hospitals it was 8.02 injuries per 100 beds). To complicate things further, other

researchers have found the opposite trend in the hospital setting (i.e., more injuries in

smaller hospitals) (Beekman, Yagla, Mccoy & Doebbeling, 1997). In short, more

research is needed to substantiate previous findings (Hasle et al., 2009; Babcock &

Fraser, 2003; Beekman, et al., 1997).

One of the only studies found in this review that assessed nurses’ causal

attributions in response to failure was by Meurier, Vincent and Parmar (1998). Based on

previous literature (Arndt, 1994), the authors postulated that attributions of nurses toward

errors might be more external. In Meurier et al’s (1998) study, 60 nurses were divided

into two groups of 30 participants. A questionnaire was provided to both groups to assess

causal attributions and participants were provided with a fictional error scenario. The first

group received a scenario that described a nonserious outcome (i.e., a medical error

noticed by another healthcare professional but brought no harm to the patient). The

second group received a scenario that described a serious outcome (i.e., medical error

resulting in patient harm). Contrary to the author’s expectations, both groups made

internal attributions and assumed responsibility for their error. However, those who


received the description of the serious outcome assumed more responsibility for the error.

The authors derived three main implications from this internal attribution style tendency.

First, this led authors to believe that because nurses accepted more responsibility,

they might be more receptive to change (i.e., with appropriate managerial involvement)

after an accident/error. It was also noted that the attribution style might be related to the

profession’s strong professional ethics (ANA, 2010; 2014), which encourages

practitioners to take responsibility for their actions (Meurier et al., 1998). Reconciling a

study by Dejoy (1990), the authors did note some limitations to assuming full

responsibility for failure such as discounting other important factors that may have also

played a role (e.g., environmental influences).

A second finding of this study is that nurses had a tendency to attribute less

importance to nearmisses or nonserious outcomes. This may lead to the underestimation

of risks and a failure to take appropriate precautions/preventative measures.

Third, nurses seemed to judge errors more harshly when the patient is harmed, a

finding that has been documented in other studies (Mitchell & Kalb, 1981). Meurier et

al., (1998) emphasized that whether harm comes to the patient or not, safety

standards/practices should be carefully evaluated in order to foster a better hazard

management climate and prevent accidents in the future. This study was limited because

it used questionnaires and fictional accident scenarios, which may have had a significant

influence on attributions and will be further discussed at the end of this paper. The

authors also did not seem to specify the type of nurses assessed in this study.


In terms of accident prevention in the industrial setting, Gyekye (2010)

emphasized the important role of causal attributions in occupational and industrial

accident analyses and the subsequent implementation of safety interventions. Expert

opinions were found to be subject to bias. For instance, engineers seemed to attribute

accidents to abnormal events resulting from a violation of safety rules (Gherardi, Nicolini

& Odella, 1998). Those knowledgeable about safety and accidents, on the other hand,

seemed to have a multifaceted way of explaining causality (Gherardi et al., 1998).

Finally, it was found that organizations with strong safety cultures tend to be more

knowledgeable of accidents and attribute in a more complex manner (Hofmann & Stetzer,

1998). Gyekye (2010) also emphasized that objective riskassessments are crucial in

causal analysis if successful safety interventions are to be implemented. With this in

mind, the next section will focus on the role of human error in accident appraisals.

Analysis of Accidents and Identification of Human Error

Understanding attributions can help researchers gain insight into conflicting

perceptions during accident analyses and the extent to which human error is involved.

Although there appears to be a lack of studies related to nursing, one study related to

healthcare will be presented in this section. The following studies serve to demonstrate

that accidents are complex and the way they are interpreted can have a significant effect

on an organization’s performance and/or reputation.

Salminen (1992) evaluated 99 serious occupational accidents in Finland and

highlighted different attribution patterns among 73 victims, 65 coworkers and 71

supervisors. With particular interest to this author was the DAT. Providing some support


for this, the results showed that victims tended to attribute externally and thus minimize

the contribution of their own behaviour. Supervisors tended to be of the view that victims

deviated from safety protocol, which minimized the contribution of their own behaviour.

Moreover, they would tend to refute any accusations that they tolerated risk taking on the

job, emphasizing the company’s strong safety practice. Coworkers tended to attribute to

the victim and they evaluated the accident as less dangerous than victims or supervisors.

They emphasized that the tasks that had resulted in injury were a part of everyday work.

This study underlines that different stakeholders of an organization attribute differently

and are vulnerable to subjective error (e.g., biases) in their appraisals of accidents.

Aquino, Tripp and Bies (2001) examined the relationship between blame, victim,

offender status and the pursuit of revenge or reconciliation after a personal offense.

Questionnaires were distributed to 141 government workers and results showed a positive

correlation between blame and revenge. Not surprisingly, blame was negatively

correlated with reconciliation. Victims who blamed wanted revenge more often when the

offender’s position in an organization’s hierarchy was lower than their own. In addition,

those of lower hierarchical status who blamed wanted revenge more often. Evidently,

blame attributions are not healthy for an organization and can impact safety culture (e.g.,

through retributional behaviour).

Walton and Hume (2012) considered consumer response to public hospital service

failure based on service type, service expectation and post failure attributions. Three

hundred participants responded to written scenarios and the researchers measured

attitudes. When an organization had a strong reputation, a service failure (e.g., wait


times) was attributed to temporary or unstable factors and expectations for the future

were maintained. In contrast, stable causes were attributed to organizations with poor

reputations (i.e., Kelley’s covariation model). The authors suggested that in order to

reassure consumers that public hospital failure is unlikely to recur the explanation offered

by the organization should focus on stability (e.g., this type of event was rare and is

unlikely to reoccur) and not uncontrollable factors (e.g., the occurrence of the event was

beyond our control). The two following sections will present a summary of the current

review as well as propose future methodology.


Summary and Future Considerations

Themes, trends and gaps have emerged from the current review. Certainly, AT

has attracted considerable interest, which has led to several, published studies that have

incorporated a variety of applications and methods to explore accidents/failures through

this unique lens.

Themes

Some researchers have emphasized the DAT, which states that observers will

assign more responsibility to the harmdoer when the outcome is severe and when

personal/situational relevancy for the victim increases (Dejoy 1989; Salminen 1992).

With accident victims, this tendency was the opposite. That is, victims tended to assign

greater responsibility to external factors and deny personal responsibility as accident

severity increased (Stewart, 2005). This merits further investigation in other occupations

(e.g., healthcare) or in other areas where DAT has yet to be applied, as there is

insufficient work in this area.

Furthermore, Hofmann and Stetzer (1998) demonstrated that safety climate and

communication could influence how attributions are made. Education/training was

thought to influence attributions of employees in organizations who have strong safety

cultures (Gonçalves et al., 2008) and with safety experts who attributed accidents to

multiple causes (Gherardi et al., 1998). A more objective and comprehensive view of

accidents was proposed for individuals who attributed in this multifaceted manner. With

external attributions, selfprotecting mechanisms that enhance selfesteem appear to be

involved in order to avoid the negative consequence of assuming responsibility (Hyland


& Cooper, 1976; Salminen, 1992; Zuckerman, 1979). In the group context, Bazarova et

al’s (2012) study demonstrated mixed results. It has also been posited by Hyland and

Cooper (1976) that externals might provide a more objective view than internals but

when judging oneself, taking credit for pleasant experience is more important. This is

important for safety inspectors or those responsible for objectively evaluating the work of

others. Depending on internal/external orientation, objectivity may be enhanced or

compromised.

Controversial findings were found in this review with regard to whether assuming

full responsibility (i.e., internal attributions) for accidents is beneficial or not. Some

researchers found that the assumption of responsibility resulted in positive outcomes such

as better coping (Nickerson et al., 2013; Stewart, 2005; Thompson et al., 2014), better

mood (Brewin, 1984) and that job satisfaction was associated with this internal attribution

style (Gyekye & Salminen, 2006). Other researchers have indicated that internal

attributions can lead to depressive symptoms, lower selfesteem, and other negative

psychological states (Miller & Norman, 1979; Peterson, 1984). It may be the case that the

assumption of responsibility affects individuals differently (e.g., high achievers versus

those with low selfesteem) such as Falbo et al., (2001) have suggested with the tendency

of high achievers to attribute more readily to effort and ability. Shaw and Breed (1977)

also suggested encouraging attribution styles that were appropriate to a client’s needs. In

any case, poor mental health is a barrier to a successful return to work and practitioners as

well as personal injury compensation systems need to assure that attention is placed not


only on physical workplace issues but mental health issues as well (Thompson et al.,

2014).

Furthermore, it has been emphasized that assuming full responsibility for an

accident/failure may result in disregarding other important factors involved in an

accident/failure (Dejoy, 1990; Meurier et al., 1998). Therefore, assuming some degree of

responsibility and attributing to multiple causes appears to be the most promising

approach for prevention. That is, in terms of personal growth, behaviour change and

having an objective comprehensive view of accidents.

In addition, the role of emotion has been shown to influence the way individuals

interpret accident/failure situations (Averill et al., 1977; Coleman, 2013). The role of

emotion should be further investigated in the context of healthcare, as there appears to be

a general lack of studies that have acknowledged this important influence in this area.

Trends

Researchers have used a variety of quantitative and qualitative methodologies to

facilitate a better understanding of attributions. In terms of methodology, questionnaires

are frequently used (Aquino et al., 2001; Brewin, 1984; Georgiou et al., 2002; Meurier, et

al., 1998; Stewart, 2005). Studies that use this method along with other highly structured

methods (e.g., structured interviews) are believed to be limited because they restrict the

breadth of participants’ subjective responses. Other methods such as semistructured

individual interviews (Hasle et al., 2009) might yield a more accurate representation of

participants’ attributions and minimize leading/closeended questions.


Furthermore, Dejoy (1987b) has emphasized the importance of accurate accident

appraisals in accident prevention. Researchers have demonstrated that attributions are

vulnerable to subjective error, which can be detrimental to organizations. That is,

voluntary/involuntary distortions of information can be detrimental to accident

investigations (Kouabenan, 2001). For instance, Gyekye (2003) emphasized that punitive

measures and greater responsibility are typically assigned to workers when supervisors

assigned internal causes (e.g., lack of effort) than when they assigned external causes

(e.g., bad luck). Due to this tendency, the causal attributions from accident victims seem

to have been distorted with selfprotective causal attributions to avoid reprisals (Gyekye

& Salminen, 2006; Salminen, 1992). Whether a voluntary distortion or not, it seems that

the ability to recognize that we are vulnerable to error and bias in our appraisal of

accidents is vital to occupational health and safety. Some researchers (Hofman & Stetzer,

1998; Rasmussen, 1990) suggest this selfawareness is not only important for those

directly involved in accidents but also for those responsible for the investigation of these

accidents (e.g., safety inspectors).

Moreover, some types of attributions might suggest that behaviour change is

unlikely (e.g., defensive attributions). External attributions have been related to

protecting one’s selfesteem (Jong, Koomen, & Mellenbergh, 1988) and they make the

learning from an accident/failure as well as personal growth less likely (Meurier et al.,

1998). If this is the case, it may be more effective to prescribe policy changes that target

the work environment. Alternatively, organizations may wish to educate workers on

accident causation and their associated attributions. It has also been suggested that


accident severity is related to stronger internal attributions from the part of the observer.

This is important for prevention. If poor performances with nonserious outcomes are

likely to be overlooked, this might result in future negative consequences and is not

effective in providing feedback to employees (Mitchell & Wood, 1980), as this approach

is reactive rather than proactive.

This review has demonstrated the importance of studying accident interpretation

with the aim of preventing and reducing accidents and injuries. In fact, Dejoy (1989)

argued that the key to any program (e.g., safety/health) is that the audience acknowledges

relevancy to themselves. However, accident situations elicit defensive mechanisms and a

denial of relevancy. It then becomes important to understand why people choose to

engage in certain behaviours and perception of responsibility for such.

Gaps

A good portion of the literature reviewed on AT with respect to accident

interpretation is dated and there appears to be a hiatus in research production. Moreover,

few studies in this review utilized Weiner’s full attribution model (i.e., stability,

controllability and locus). Most often, the locus dimension was used (Davis & Davis,

1971; Kouabenan, 1998). Stability and controllability were emphasized less (Lacroix &

Dejoy, 1989). Many studies made no references to biases. Also, there was little

differentiation of the multiple actors that are usually involved in accidents.


Furthermore, as Buss’s (1978) critique has emphasized, there seems to be an

insufficient vocabulary differentiation between cause and reason in the attribution

literature. Future researchers may wish to differentiate this type of terminology in order

to offer a better understanding of participant attributions.

The application of AT to accidents in healthcare occupations is scarce. Although

there were some studies that have investigated mining (Brewin, 1984; Gyekye, 2003;

Gyekye & Salminen, 2006) there still seems to be a lack of studies that have investigated

occupations with a higher prevalence of accidents, disability rates and/or lost time. With

the nursing profession representing one of the most stressful healthcare occupations

(Berrios et al., 2015; Wilkins, 2007) and psychiatric nurses facing considerable

challenges (i.e., patient aggression/violence), this increases their chances of experiencing

occupational accidents. Therefore, this population, along with others facing similar

challenges such emergency nurses (Gacki, et al., 2009; Gillespie, Gates & Berry, 2013;

Luck, Jackson & Usher, 2007) require particular attention from researchers.

Peterson, (1984) suggested psychiatric nurses require training to recognize

counterproductive attributions in their patients. This therapeutic strategy has been

referred to as the “reattribution process” and involves encouraging patients to seek

alternative explanations for their observations. To this writer’s knowledge, no study has

examined the attributions and biases (or lack of) offered by mental health workers for the

occupational accidents they have experienced.


Research with this population merits investigation as the findings could help

develop targeted preventions and facilitate change in occupational health and safety

practice for nursing and potentially other occupations. This could translate into

improvements in workplace safety, productivity, and health. It could also result in

organizational safety culture growth, the prevention of occupational injuries, the

improvement in lost time and associated consequences (e.g., stress leave). Previous

research with nurses has suggested that this population might be more likely to assume

responsibility and this is especially true when harm comes to a patient (Meurier et al.,

1998). This suggests nurses might be receptive to change and that studying them might

help guide interventions.

Proposed Methodology for Future Studies

The findings from this review may encourage researchers to explore the

interpretation of accident causation in healthcare occupations with special attention to

nurses and nursing specialties (e.g., psychiatric nurses). The theoretical framework

should draw from AT and consider every dimension of Weiner’s (1985; 2010) model.

Moreover, researchers could take advantage of various tools that have been created to

better understand worker attributions for accidents. In this regard, Martinko et al., (2006)

have emphasized the usefulness of the Revised Occupational Attributional Style

Questionnaire (ROASQ) by Furnham, Brewin and O’Kelly (1994).

Additional qualitative methodologies are encouraged in future studies in order to

offer participants opportunities to elaborate on the occupational accidents they have

experienced. Various types of analyses are available in this regard (e.g., thematic analysis


or interpretive description analysis). When analyzing participant responses, it is

recommended that researchers work in interdisciplinary teams. An interdisciplinary

research approach might be useful in identifying/minimizing personal biases and

strengthening objectivity. Multiple perspectives could also potentially help capture a

more comprehensive view of attributions by participants.

Researchers may want to deemphasize hypothetical accident/failure scenarios

(Cox, 2014; Meurier et al., 1998; Rickard, 2014) to explore accident interpretation as

previous authors (Kouabenan, 1985; Salminen, 1992) have suggested that attributions

from a real accident might differ from fictional accidents. That is, there is more personal

involvement in a real accident as opposed to a fictional one (Kouabenan, 1985).

Moreover, in order to better understand the interpretations offered and the biases

that may emerge by participants, it is recommended that the attributions of actors and

witnesses be compared during analyses. This would allow the researcher(s) to discover

perception themes and/or differences among subjects.

It is also recommended that semistructured individual interviews be used as

opposed to other methods (e.g., focus groups) to fully capture the interpretations offered

by each participant. Leung and Savithiri (2009) have emphasized that while focus groups

carry many advantages (e.g., participants can build on each other’s thoughts), they also

carry some limitations. Outspoken individuals have been known to “dominate” focus

group discussion (Leung & Savithiri, 2009), which is evidently troublesome for the

analysis of multiple participant attributions. The best strategy seems to be finding a

method that is not so structured that it limits the breadth of participants responses, but has


enough structure to guide the researcher in gaining a deep understanding of participant

attributions (e.g., stability, controllability and locus of control factors). Semistructured

interviews seem to fit this description.

In conclusion, researchers have compiled significant work to better understand

occupational accidents and determining appropriate strategies for prevention. Kelloway,

Francis and Gatien (2014) define due diligence as “an expected standard of conduct that

requires us to take every reasonable precaution to ensure safety” (Kelloway et al., 2014,

p.10). If due diligence is to be satisfied, researchers must further investigate accident

interpretation with particular attention placed on populations vulnerable to accidents. It is

also suggested that instead of simply testing new prevention initiatives, these initiatives

can be created according to the needs of a population. That is, researchers can use AT as

a tool to investigate why individuals believe the accident/failure has occurred and create

targeted preventions according to the needs identified. Ultimately, since those at the

frontline may be directly experiencing accidents, they can and should be valuable and

insightful contributors of knowledge in this area. Abood (2007) states that nurses should

be proactively involved in the creation/decisionmaking of new policies (e.g., safety,

health). He further emphasized “nurses are often the first providers to see clearly when

and how the healthcare system is not effectively meeting patient needs” (Abood, 2007,

p.1). That being said, this review has highlighted various attribution tendencies/patterns

in a variety of individuals and contexts. However, it is likely the case that studying

specific worker populations will most facilitate targeted preventions.


REFERENCES

Abood, S. (2007). Influencing health care in the legislative arena. Online Journal of

Issues in Nursing, 12(1), 2.

Arndt, M. (1994). Nurses’ medication errors. Journal of Advanced Nursing, 19(3),

519526.

Arnetz, J., Hamblin, L., Essenmacher, L., Upfal, M., Ager, J., Luborsky, M. (2014).

Understanding patienttoworker violence in hospitals: a qualitative analysis of

documented incident reports . Journal of Advanced Nursing, 71(2), 338348.

American Nurses Association (ANA) (2010). Public rates nurses most honest. Nurses

retain top spot as most ethical profession. Wyoming Nurse, 9.

American Nurses Association (ANA) (2014). Public rates nurses most honest and ethical

for 13th straight year. Retrieved from

http://nursingworld.org/NursesMostHonestEthicalProfession.

Aquino, K., Tripp, T., & Bies, R. (2001). How employees respond to personal offense:

The effects of blame attribution, victim status, and offender status on revenge and

reconciliation in the workplace. Journal of Applied Psychology, 86(1), 5259.

Association of Workers' Compensation Boards of Canada (AWCBC) (2013). Injury

statistics. Retrieved from http://awcbc.org/?page_id=14#injuries.

Averill, J., DeWitt, G., & Zimmer, M. (1977). The selfattribution of emotion as a

function of success and failure. Journal of Personality, 46(2), 323347.


Babcock, H. M., & Fraser, V. (2003). Differences in percutaneous injury patterns in a

multi‐hospital system. Infection Control and Hospital Epidemiology, 24(10),

731736.

Barling, J., Loughlin, C., & Kelloway, E. K. (2002). Development and test of a model

linking safetyspecific transformational leadership and occupational safety.

Journal of Applied Psychology, 87(3), 488496.

Bartholomew, J. B., Morrison, D., & Ciccolo, J. T. (2005). Effects of acute exercise on

mood and wellbeing in patients with major depressive disorder. Medicine &

Science in Sports & Exercise, 37(12), 20322037.

Bazarova, N. N., & Hancock, J. T. (2012). Attributions after a group failure: do they

matter? Effects of attributions on group communication and performance.

Communication Research, 39(4), 499522. doi:10.1177/0093650210397538.

Beekmann, S. E., Yagla, S., Mccoy, K., & Doebbeling, B. N. (1997). Sharps injury rates

in small, rural hospitals vs large, urban hospitals Results of a statewide survey.

Clinical Infectious Diseases , 25(2), 472.

Berrios, C., Joffres, Y., & Wang, L. (2015). Workplace psychological health among

canadian nurses. UBC Medical Journal, 6(2), 3032.

Brewin, C. (1984). Attributions for industrial accidents: their relationship to rehabilitation

outcome. Journal of Social and Clinical Psychology, 2(2), 156164.

Broderick, P., & Sewell, T. (2001). Attributions for success and failure in children of

different social class. Journal of Social Psychology, 125(5), 591599.


Brotheridge, C.M., & Lee, R. T. (2003). Development and validation of the emotional

labour scale. Journal of Occupational and Organizational Psychology, 76(3),

365379.

Bruce, S., Sale, J. E., Shamian, J., O’BrienPallas, L., & Thomson, D. (2002).

Musculoskeletal injuries, stress and absenteeism. Canadian Nurse, 98(9), 127.

Bureau of Labor Statistics, U.S. Department of Labor (2006), The Economics Daily.

Workplace injuries and illnesses among nursing, psychiatric, and home health

aides. Retrieved from http://www.bls.gov/opub/ted/2006/jul/wk1/art01.html.

Buss, A.R. (1978). Cause and reasons in attribution theory: a conceptual critique. Journal

of Personality and Social Psychology 36(11), 13111321.

Byrns, G., Reeder, G., Jin, G., & Pachis, K. (2004). Risk factors for workrelated low

back pain in registered nurses, and potential obstacles in using mechanical lifting

devices. Occupational Environment and Hygiene, 1(1), 1121.

Canadian Labour and Business Centre (2002). Fulltime equivalents and financial costs

associated with absenteeism, overtime, and involuntary parttime employment in

the nursing profession. Report commissioned for the Canadian Nursing Advisory

Committee, Ottawa, ON. Retrieved from

http://en.copian.ca/library/research/clbc/fulltime/02feb15.pdf.


Canadian Nurses Association (CNA) (2004). Building the Future: an integrated strategy

for nursing human resources in Canada. Canadian Survey of Nurses from Three

Occupational Groups. Retrieved from

https://www.cnaaiic.ca/~/media/cna/pagecontent/pdf.

fr/canadian_nurses_survey_3occupational_groups_e.pdf?la=en.

Caponecchia, C. (2010). It won't happen to me: an investigation of optimism bias in

occupational health and safety. Journal of Applied Social Psychology, 40(3),

601617. doi:10.1111/j.15591816.2010.00589x.

Centre for Disease Control and Prevention (2015). Occupational traumatic injuries among

workers in health care facilities – United States. Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6415a2.html.

Clarke, S. P., Rockett, J. L., Sloane, D. M., & Aiken, L. H. (2002). Organizational

climate, staffing, and safety equipment as predictors of needlestick injuries and

nearmisses in hospital nurses. American Journal of Infection Control, 30(4),

207216.

Coleman, M. (2013). Emotion and the ultimate attribution error. Current Psychology,

32(1), 7181.

CortésSuárez, G., & Sandiford, J. (2008). Causal attributions for success or failure of

students in college algebra. Journal of Research and Practice, 32(46), 325346.

Cox, B., & Margaret, E. (2014). Too old to train or reprimand: the role of intergroup

attribution bias in evaluating older workers. Journal of Business and Psychology,

29(1), 6170.


Davis, W., & Davis, D. (1971). Internalexternal control and attribution of responsibility

for success and failure. Journal of Personality, 40(1), 123136.

Dejoy, D.M. (1985). Attribution of responsibility for alcoholrelated motor vehicle

collisions. American Association for Automotive Medicine, 29, 7590.

Dejoy, D.M. (1987a). Perpetrators’ and servers’ responsibility and punishment for drunk

driving outcomes. Perceptual and Motor Skills , 64, 455460.

Dejoy, D.M. (1987b). Supervisor attributions and responses for multicausal workplace

accidents. Journal of Occupational Accidents , 9(3), 213223.

Dejoy, D.M. (1989). An attribution theory perspective on alcoholimpaired driving.

Health Education and Behaviour, 16(3), 359372.

Dejoy, D. (1990). Spontaneous attribution thinking following nearmiss and loss

producing traffic accidents. Journal of Safety Research, 21(3), 115124.

Dejoy, D. M. (1994). Managing safety in the workplace: an attribution theory analysis

and model. Journal of Safety Research, 25(1), 317.

doi:10.1016/00224375(94)900035.

Dejoy, D.M., & Klippel, J.A. (1984). Attributing responsibility for alcoholrelated

nearmiss accidents. Journal of Safety Research, 15(3), 107115.

Dossett, D., & Greenberg, C. (1981). Goal setting and performance evaluation: an

attributional analysis. Academy of Management Journal, 24(4), 767779. doi:

10.2307/256175.


Fabiano, B., Curro, F., & Pastorino, R. (2004). A study of the relationship between

occupational injuries and firm size and type in the Italian industry. Safety Science,

42, 587600.

Falbo, T., Wernick, M., & Rowen, M. (2001). The onset of asymmetries in attributions

about success and failure. The Journal of Genetic Psychology, 139(1) , 3545.

Felson, R., & Ribner, S. (1981). An attributional approach to accounts and sanctions for

criminal violence. Social Psychology Quarterly, 44(2), 137142.

Feather, N.T., & Simon, J.G. (1969). Attribution of responsibility and valence of success

and failure in relation to initial confidence and task performance. Journal of

Personality and Social Psychology, 13, 129144.

Fitch, G., (1970). Effects of selfesteem, perceived performance and choice on causal

attributions. Journal of Personality and Social Psychology, 16, 311315.

Fincham, F.D., & Jaspars, J. M. (1980). Attribution of responsibility: from man the

scientist to man as lawyer. Advances in experimental social psychology 13,

81138.

Fischhoff, B. (1975). Hindsight is not equal to foresight: the effect of outcome knowledge

on judgment under uncertainty. Journal of Experimental Psychology: Human

Perception and Performance, 1(3), 288299.

Furnham, A., Brewin, C., & O’Kelly, H. (1994) Cognitive Style and attitudes to work.

Human Relations , 47, 15091521.


Gabrovec, B., & Lobnikar, B. (2014). Organizational model of ensuring safety and

quality of treatment of aggressive psychiatric patients in mental health nursing in

Slovenia. Obzornik Zdravstvene Nege, 48(4), 286293.

doi:10.14528/snr.2014.48.4.33.

GackiSmith, J., Juarez, A. M., Boyett, L., Homeyer, C., Robinson, L., & Maclean, S. L.

(2009). Violence against nurses working in US emergency departments. Journal

of Nursing Administration, 39(7), 340349.

Georgiou, S., Christou, C., Stavrinides, P., & Panaoura, G. (2002). Teacher attributions of

student failure and teacher behaviour toward the failing student. Psychology in the

Schools, 39(5), 583595.

Gherardi, S., Nicolini, D., & Odella, F. (1998). What do you mean by safety? Conflicting

perspectives on accident causation and safety management in a construction firm.

Journal of Contingencies and Crisis Management, 6, 202212.

Gibson, D., & Schroeder, S. (2003). Who ought to be blamed? The effect of

organizational roles on blame and credit attributions. International Journal of

Conflict Management, 14(2), 95117.

Gillespie, L., Gates, D., & Berry, P. (2013). Stressful incidents of physical violence

against emergency nurses. Online Journal of Issues in Nursing, 18(1), 2.

Gomaa, A., Tapp, L., Luckhaupt, S., Vanoli, K., Sarmiento, R., Raudabaugh, W., Sprigg,

S. (2015). Occupational traumatic injuries among workers in health care facilities.

United States, 2012–2014. Morbidity and Mortality Weekly Report, 64(15),

405410.


Gonçalves, S. M. P., da Silva, S. A., Lima, M. L., & Meliá, J. L. (2008). The impact of

work accidents experience on causal attributions and worker behaviour. Journal

of Applied Psychology, 46(6), 9921001. doi:10.1016/j.ssci.2007.11.002.

Gyekye, S. A. (2003). Causal attributions of Ghanaian industrial workers for accident

occurrence: Miners and nonminers perspective. Journal of Safety Research,

34(5), 533538. doi:10.1016/j.jsr.2003.03.002.

Gyekye, S. A. (2010). Occupational safety management: the role of causal attribution.

International Journal of Psychology, 45(6), 405416.

doi:10.1080/00207594.2010.501337.

Gyekye, S.A., & Salminen, S. (2006). Making sense of industrial accidents: the role of

job satisfaction. Journal of Social Sciences, 2(4), 127134.

Hackett, R. D., & Bycio, P. (1996). An evaluation of employee absenteeism as a coping

mechanism among hospital nurses. Journal of Occupational and Organizational

Psychology, 69(4), 327338.

Hamilton, V.L., & Sanders. J. (1981). The effect of roles and deeds on responsibility

judgments: the normative structure of wrongdoing. Social Psychology Quarterly,

44(3), 237254.

Hasle, P., Kines, P., & Andersen, L. P. (2009). Small enterprise owners’ accident

causation attribution and prevention. Safety Science, 47(1), 919.

doi:10.1016/j.ssci.2007.12.005.

Heider, F. (1944). Social perception and phenomenal causality. Psychological Review,

51(6), 358374.


Health Canada (2002). Final report of the Canadian nursing advisory committee.

Retrieved from

http://www.hcsc.gc.ca/hcssss/pubs/nursIinfirm/2002cnaccccsifinal/indexeng

.php.

Health Canada (2007). The working conditions of nurses: confronting the challenges.

Retrieved from

http://www.hcsc.gc.ca/srsr/pubs/hprrpms/bull/2007nursesinfirmieres/indexen

g.php.

Health Canada (2013a). Our health, our future: creating quality workplaces for Canadian

nurses. Retrieved from

http://www.hcsc.gc.ca/hcssss/pubs/nursinfirm/2002cnaccccsifinal/indexeng.

php.

Health Canada (2013b). Findings from the 2005 national survey of the work and health of

nurses. Retrieved from

https://www.cihi.ca/en/nursing_nswhn_summary2005_en.pdf.

Health Canada (2013c). Trends in workplace injuries, illnesses, and policies in healthcare

across Canada. Retrieved from

http://www.hcsc.gc.ca/hcssss/pubs/nursinfirm/2004hwiipsmt/indexeng.php.

Henderson, A.D. (2003). Nurses and workplace violence: nurses' experiences of verbal

and physical abuse at work. Nursing Leadership, 16(4), 8298.


Hewstone, M. (1990). The ‘ultimate attribution error’? A review of the literature on

intergroup causal attribution. European Journal of Social Psychology, 20(4),

311335.

Hewstone, M., & Ward, C. (1985). ‘Ethnocentrism and causal attribution in Southeast

Asia’. Journal of Personality and Social Psychology, 48(3), 614623.

Hofmann, D., & Stetzer, A. (1998). The role of safety climate and communication in

accident interpretation: implications for learning from negative events. Academy

of Management Journal, 41(6), 644657.

Hoskins, A. (2006). Occupational injuries, illnesses, and fatalities among nursing,

psychiatric, and home health aides, 19952004. Retrieved from

http://phinational.org/researchreports/occupationalinjuriesillnessesandfatalitie

samongnursingpsychiatricandhome.

Humaida, I.A.I. (2012). Relationship between stress and psychosomatic complaints

among nurses in a Tabarial hospital. Journal of Medical Psychology, 1, 1519.

Humble F., & Cross W. (2010). Being different: a phenomenological exploration of a

group of veteran psychiatric nurses. International Journal of Mental Health

Nursing 19(2), 128136.

Hutchinson, M., Jackson, D., Wilkes, L., & Vickers, M. H. (2008). A new model of

bullying in the nursing workplace. Advances in Nursing Science, 31(2).

Hyland, R., & Cooper, M. (1976). Internalexternal control and attribution of

responsibility for a positive accident. Journal of Social Psychology, 99(1),

147148.


International Council of Nurses (2004). Guidelines on coping with violence in the

workplace [Position statement]. Retrieved from

http://www.icn.ch/images/stories/documents/publications/guidelines/guideline_vi

olence.pdf.

Ito, H., Eisen, S. V., Sederer, L. I., Yamada, O., & Tachimori, H. (2001). Factors

affecting psychiatric nurses’ intention to leave their current job. Psychiatric

Services, 52(2), 232234.

Jackson, J., & Morrissette, P. (2014). Exploring the experience of Canadian registered

psychiatric nurses: A phenomenological study. Journal of Psychiatric and Mental

Health Nursing, 21(2), 138144. doi:0.1111/jpm.12064.

Jacobowitz, W. (2013). PTSD in psychiatric nurses and other mental health providers: a

review of the literature. Issues in Mental Health Nursing, 34(11), 787795.

Jeong, S.H. (2009). Public's responses to an oil spill accident: a test of the attribution

theory and situational crisis communication theory. Public Relations Review,

35(3), 307309. doi:10.1016/j.pubrev.2009.03.010.

Johnston, D. W., Jones, M. C., Charles, K., Mccann, S. K., & Mckee, L. (2013). Stress in

nurses: stressrelated affect and its determinants examined over the nursing day.

Annals of Behavioral Medicine, 45(3), 348356.

Jones, E.E., & Davis, K.E. (1965). From acts to dispositions: the attribution process in

person perception. Advances in experimental social psychology, 2, 219266.


Jones, E.E., Kanouse, D.E., Kelley, H.H., Nisbett, R.E., Valins, S., & Weiner, B. (Eds.)

(1972). Attribution: Perceiving the causes of behaviour . Morristown, NJ: General

Learning Press.

Jong, P. F., Koomen, W., & Mellenbergh, G. J. (1988). Structure of causes for success

and failure: A multidimensional scaling analysis of preference judgments. Journal

of Personality and Social Psychology, 55(5), 718725.

Kane (2009). Stress causing psychosomatic illness among nurses. Indian Journal of

Occupational and Environemental Medicine, 13(1) , 2832.

Karasek, R., Baker, D., Marxer, F., Ahlbom, A., & Theorell, T. (1981). Job decision, job

demands, and cardiovascular disease. American Journal of Public Health, 71,

694705.

Karlovac, M., & Darley, J. (1988). Attribution of Responsibility for Accidents: A

negligence law analogy. Social Cognition, 6(4), 287318.

Kelley, H.H. (1967). Attribution theory in social psychology. Levine (Ed.), Nebraska

symposium on motivation, 15, 192238.

Kelley, H.H. (1971). Attribution in social interaction. Morristown, NJ: General Learning

Press.

Kelley, H.H. (1973). The process of causal attribution. American Psychologist, 28(2),

107128.

Kelloway, K., Francis, L., & Gatien, B. (2014). Psychosocial hazards. Management of

Occupational Health and Safety (6th ed., pp. 167195). Toronto: Nelson

Education.


Kitts, J. (2013). Psychological health and safety in Canadian healthcare settings.

Healthcare Quarterly, 16(4), 69.

Klein, D.C., FencilMorse, E., & Selignman, M. E. P. (1976). Learned helplessness,

depression and the attribution of failure. Journal of Personality and Social

Psychology, 33, 508516.

Kouabenan, D. (1985). Degree of involvement in an accident and causal attribution.

Journal of Occupational Accidents, 7, 187194.

Kouabenan, D. (1998). Beliefs and the perception of risks and accidents. Risk Analysis,

18(3), 243252.

Kouabenan, D., Medina, M., Gilibert, D., & Bouzon, F. (2001). Hierarchical position,

gender, accident severity, and causal attribution. Journal of Applied Social

Psychology, 31(3), 553575.

Kuiper, N. A. (1978). Depression and causal attributions for success and failure. Journal

of Personality and Social Psychology, 36, 236246.

Lacroix, D., & Dejoy, D. (1989). Causal attributions to effort and supervisory response to

workplace accidents. Journal of Occupational Accidents, 11, 97109.

Lee, S., & Calamaro, C. (2012). Nursing bias and the obese patient: the role of the

clinical nurse leader in improving care of the obese patient. Bariatric Nursing and

Surgical Patient Care, 7(3), 127131. doi:10.1089/bar.2012.9968.


Lennon, A., Watson, B., Arlidge, C., & Fraine, G. (2011). 'You're a bad driver but I just

made a mistake’: Attribution differences between the 'victims' and the

'perpetrators' of scenariobased aggressive driving incidents. Transportation

Research, 14, 209211.

Leung, F.H., & Savithiri, R. (2009). Spotlight on focus groups. Canadian Family

Physician, 55(2).

Lipscomb, J. A., Trinkoff, A. M., GeigerBrown, J., & Brady, B. (2002). Workschedule

characteristics and reported musculoskeletal disorders of registered nurses.

Scandinavian Journal of Work Environment and Health, 28(6), 394401.

Lowe T., Wellman N., & Taylor R. (2003) Limited setting and decisionmaking in the

management of aggression. Journal of Advanced Nursing 41(2), 154161.

Luck, L., Jackson, D., & Usher, K. (2007). Components of observable behaviour that

indicate potential for patient violence in emergency departments. Journal of

Advanced Nursing, 59(1), 1119.

Maidinsah, H., Embong, R., Wahab, Z., & Wahab, A. (2014). Causal attributions for

success and failure in mathematics among MDAB prediploma students.

American Institute of Physics Conference Series 1605(1) 763768.

Malle, B. F. (2006). The actorobserver asymmetry in attribution: A (surprising)

metaanalysis. Psychological Bulletin, 132(6), 895919.

Marshall, K. (1996). A job to die for. Retrieved from

http://www.statcan.gc.ca/pub/75001x/1996002/2889eng.pdf.


Mann, S., & Cowburn, J. (2005). Emotional labour and stress within mental health

nursing. Journal of Psychiatric and Mental Health Nursing, 12(2), 154162.

Martinko, M. J. (1995). Attribution theory: an organizational perspective. Delray Beach,

FL: St. Lucie Press.

Martinko, M. J. (2002). Thinking like a winner. A guide to high performance leadership.

Tallahasee, FL.: Gulf Coast Publishing.

Martinko, M., Douglas, S., & Harvey, P. (2006). Attribution theory in industrial and

organizational psychology: a review. International Review of Industrial and

Organizational Psychology, 21, 131187.

Mccarthy, P. (1985). Burnout in psychiatric nursing. Journal of Advanced Nursing,

10(4), 305310. doi:10.1111/j.13652648.1985.tb00823.x.

Mctiernan, K., & McDonald, N. (2015). Occupational stressors, burnout, coping

strategies between hospital and community psychiatric nurses in a Dublin region.

Journal of Psychiatric Mental Health Nursing, 22(3), 208218.

Mckenna, B. G., Poole, S. J., Smith, N. A., Coverdale, J. H., & Gale, C. K. (2003). A

survey of threats and violent behaviour by patients against registered nurses in

their first year of practice. International Journal of Mental Health Nursing, 12(1),

5663. doi:10.1046/j.14400979.2003.00269.x.

Melchior, M., Bours, G., Schmitz, P., & Wittich, Y. (1997). Burnout in psychiatric

nursing: A metaanalysis of related variables. Journal of Psychiatric and Mental

Health Nursing, 4, 193201.


Mendeloff, J.M., & Kagey, B.T., (1990). Using occupational safety and health

administration accident investigations to study patterns in work fatalities. Journal

of Occupational Medicine. 32, 11171123.

Meurier, C.E., Vincent, C.A., & Parmar, D.G., (1998). Nurses' responses to severity

dependent errors: A study of the causal attributions made by nurses following an

error. Journal of Advanced Nursing, 27(2), 349354.

Miller, I., & Norman, W. (1979). Learned helplessness in humans: a review and

attributiontheory model. Psychological Bulletin, 86(1), 93118.

Mitchell, T. R., & Wood, R. E. (1980). Supervisor's responses to subordinate poor

performance: A test of an attributional model. Organizational Behaviour and

Human Performance, 25(1), 123138. doi:10.1016/00305073(80)90029X.

Mitchell, T., & Kalb, L. (1981). Effects of outcome knowledge and outcome valence on

supervisors' evaluations. Journal of Applied Psychology, 66(5), 604612.

Mullen, B., Atkins, J. L., Champion, D. S., Edwards, C., Hardy, D., Story, J. E., &

Vanderklok, M. (1985). The false consensus effect: a metaanalysis of 115

hypothesis tests. Journal of Experimental Social Psychology, 21(3), 262283.

Muthuvenkatachalam, S., Chetana, H., Pooja, J., Sandhya, N., & Sonika, P. (2014).

Effectiveness of aggression management training program for staff nurses and

ward attendants working in selected psychiatric hospital. Journal of Psychiatric

Nursing, 3(1), 140.


Myon, N., & Robinson P. (2012) The safety of nurses during the restraining of aggressive

patients in an acute psychiatric unit. Australian Journal of Advanced Nursing

29(3), 513.

Nickerson, A., Aderka, I., Bryant, R., & Hofmann, S. (2013). The role of attribution of

trauma responsibility in posttraumatic stress disorder following motor vehicle

accidents. Depression and Anxiety, 30(5), 483488.

O’BrienPallas, L., Shamian, J., Thomson, D., Alksnis, C., Koehoorn, M., Kerr, M., &

Bruce, S. (2004). Workrelated disability in Canadian nurses. Journal of Nursing

Scholarship 36(4), 352357.

Olpin, M., & Hesson, M. (2010). Stress management for life: A researchbased

experiential approach (3rd ed.). Belmont, CA: Wadsworth/Cengage Learning.

Orpen, C. (1981). Causal attributions for the success and failure of black and white

managers. Journal of Occupational Behaviour, 2(2), 8187.

Ovayolu, Ö., Ovayolu, N., & Karadag, G. (2014). Workplace bullying in nursing.

Workplace Health and Safety, 62(9), 370374.

Özarslan, A. (2011). Occupational accidents among the nurses. BioMed Central

Proceedings, 5(6). doi:10.1186/175365615S6P288.

Peluso, M.A., & Silveira Guerra de Andrade, L.H., (2005). Physical activity and mental

health: the mood association between exercise and mood. Clinics , 60(1), 6170.

Peterson, L. (1984). Atttribution theory and its application in crisis intervention.

Perspectives in Psychiatric Care, 22( 4), 133136.


Petri, H., & Govern, J. (2013). Cognitive motivation: attribution approaches. In

Motivation: Theory, research and application (6th ed.). Belmont, CA:

Wadsworth, Cengage Learning.

Pettigrew, T. F. (1979). The ultimate attribution error. Extending Allport’s cognitive

analysis of prejudice. Personality and Social Psychology Bulletin, 5, 461476.

Pittman, T.S., & D'Agostino. P.R. (1985). Motivation and attribution: the effects of

control deprivation on subsequent information processing. Journal of

Experimental Social Psychology, 25(6), 465480.

doi: 10.1016/00221031(89)900012.

Poster, E.C. (1996). A multinational study of psychiatric nursing staffs' beliefs and

concerns about work safety and patient assault. Archives of Psychiatric Nursing;

10(6), 36573.

Rajbhandary, S., & Basu, K. (2010). Working conditions of nurses and absenteeism: Is

there a relationship? An empirical analysis using National Survey of the Work

and Health of Nurses. Health Policy, 97(23), 152159.

Rasmussen, J. (1990). The role of error in organizing behavior. Ergonomics , 33,

11851199.

Rauhala, A., Kivimäki, M., Fagerström, L., Elovainio, M., Virtanen, M., Vahtera, J., &

Kinnunen, J. (2007). What degree of work overload is likely to cause increased

sickness absenteeism among nurses? Evidence from the RAFAELA patient

classification system. Journal of Advanced Nursing, 57(3), 286295.


Rickard, L. N. (2014). Perception of risk and the attribution of responsibility for

accidents. Risk Analysis , 34(3), 514528. doi:10.1111/risa.12118.

Rudman, A., & Gustavsson, J. (2012). Burnout during nursing education predicts lower

occupational preparedness and future clinical performance: A longitudinal study.

International Journal of Nursing Studies , 49(8), 9881001.

http://dx.doi.org/10.1016/j.ijnurstu.2012.03.010.

Roese, N.J., & Vohs, K.D. (2012). Hindsight bias. Perspective Psychological Science,

7(5), 411426. doi: 10.1177/1745691612454303.

Rotter, J. (1966). Generalized expectancies for internal versus external control of

reinforcements, Psychological Monographs , 80(69).

Ross, L. (1977). The intuitive psychologist and his shortcomings: distortions in the

attribution process. Advances in experimental social psychology, 10, 173220.

Salminen, S. (1992). Defensive attribution hypothesis and serious occupational accidents.

Psychological Reports , 70(3), 11951199.

Shamian, J., Kerr, M. S., Spence Laschinger, H. K., & Thomson, D. (2002). A

hospitallevel analysis of the work environment and workforce health indicators

for registered nurses in Ontario’s acutecare hospitals. Canadian Journal of

Nursing Research, 33(4), 3550.

Shaw, M., & Breed, G. (1970). Effects of attribution of responsibility for negative events

on behaviour in small groups. Sociometry, 33(4), 382393.

Shepperd, J., Malone, W., & Sweeny, K. (2008). Exploring causes of the selfserving

bias. Social and Personality Psychology Compass , 2(2), 895908.


Schlenker B.R., Miller, R.S. (1977). Group cohesiveness as a determinant of egocentric

perceptions in cooperative groups. Human Relations , 30, 10391055.

Sims, T., Graves, R., & Simpson, G.C. (1984). Mineworkers scores for the rotter internal

external locus of control scale. Journal of Occupational Psychology, 57, 327329.

Sprinks, J. (2015). Burnout among nurses. Emergency Nurse, 22(9), 1717.

Statistics Canada (2005). Factors related to onthejob abuse of nurses by patients.

Retrieved from

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.535.1569&rep=rep1&t

ype=pdf.

Stebbins, P., & Stone, G. (1977). Internalexternal control and the attribution of

responsibility under questionnaire and interview conditions. Journal of

Counseling Psychology, 24(2), 165168.

Stevens, G. (1999). Features – workplace injuries in small and large manufacturing

workplaces – an analysis of the risks of fatal and nonfatal injuries, including

figures for 1994/51995/6. Labour Market Trends 107(1), 1926.

Stevenson, K. N., Jack, S. M., O’Mara, L., & Legris, J. (2015). Registered nurses’

experiences of patient violence on acute care psychiatric inpatient units: an

interpretive descriptive study. BMC Nursing, 14(1).

Stewart, A. E. (2005). Attributions of responsibility for motor vehicle crashes. Accident

Analysis and Prevention, 37(4), 681688. doi:10.1016/j.aap.2005.03.010.


Suzuki, K., Ohida, T., Kaneita, Y., Yokoyama, E., Miyake, T., Harano, S., Uchiyama, M.

(2004). Mental health status, shift work, and occupational accidents among

hospital nurses in Japan. Journal of Occupational Health, 46(6), 448454.

Tangestani, Y., Khalafi, A., Esmaeily, S., (2014). The relationship between stress and the

prevalence of psychosomatic disorder symptoms in ICU nurses. Advances in

Asian Social Sciences, 5(1), 936938.

Tennen, H., & Eller, S. J. (1977). Attributional components of learned helplessness and

facilitation. Journal of Personality and Social Psychology, 35, 265271.

Thompson, J., O’Donnell, M., Stafford, L., Nordfjaern, T., & Berk, M. (2014).

Association between attributions of responsibility for motor vehicle crashes,

depressive symptoms, and return to work. Rehabilitation Psychology, 58,

376385.

Tomy, A. (2014). Strategies for managing aggressive, violent and potentially violent

patients and safety precautions for the nurse practitioner. Journal of Psychiatric

Nursing, 3(2), 4176.

Waller, T., Lampman, C., & LupferJohnson, G. (2012). Assessing bias against

overweight individuals among nursing and psychology students: an implicit

association test. Journal of Clinical Nursing, 21(2324), 35043512.

doi:http://dx.doi.org/10.1111/j.13652702.2012.04226.x.

Walster, E. Assignment of responsibility for an accident (1966). Journal of Personality

and Social Psychology, 3(1), 7379.


Walton, A., & Hume, M. (2012). Examining public hospital service failure: the influence

of service failure type, service expectations, and attribution on consumer

response. Journal of Nonprofit and Public Sector Marketing, 24(3), 202221.

doi:10.1080/10495142.2012.705179.

Weary, G., Stanley, M., & Harvey, J. (1989). Introduction to basic attribution theories.

New York: SpringerVerlag.

Weber, A., & JaekelReinhard, A. (2000). Burnout syndrome: a disease of modern

societies? Occupational Medicine, 50(7), 512517. doi:09627480/00.

Weiner, B. (1979). A theory of motivation for some classroom experiences. Journal of

Educational Psychology, 71(1), 325.

Weiner, B. (1985). An attributional theory of achievement motivation and emotion.

Psychological Review, 92(4) 548573.

Weiner, B. (1987). The social psychology of emotion: applications of a naïve

psychology: Journal of Social and Clinical Psychology, 5, 405419.

Weiner, B. (2010). The development of an attributionbased theory of motivation: a

history of ideas. Educational Psychologists , 45(1), 2836.

Wilkins, K. (2007). Workplace stress among healthcare providers. Health Reports, 18(4),

3336.

Worksafe BC, (2012). Statistics. Retrieved from

http://worksafebc.com/publications/reports/statistics

reports/assets/pdf/stats2012.pdf.


Zhang, J., Gao, S., & Yao, Y., (2011). Comparison of unsafe behaviors and accidents

attribution. Management and Safety Science, 14.

Zuckerman, M. (1979). Attribution of success and failure revisited: the motivational bias

is alive and well in attribution theory. Journal of Personality, 47(2) 245287.


APPENDICES

Appendix 1: 2013 Injury Statistics by Industries in Canada (AWCBC, 2013).

Appendix 2: Comparison of OSHArecordable workplace violence injury incidence rates per 10,000 workermonths by year among 112 U.S. health care facilities (Centre for Disease Control and Prevention, 2015).


Appendix 3: Incidence of injuries in the U.S. health care facilities by occupation type (Center for Disease Control and Prevention, 2015).

Appendix 4: Demonstrates that back strain injury with Health and Medicine are at 33% in British Columbia (WorkSafe BC, 2012).


Appendix 5: Demonstrates the percentage of injuries and illnesses involving days away from work for Nurses and aides for selected events in the United States (Bureau of Labor Statistics, 2006).

Appendix 6: Model of achievement–related events adapted by Petri and Govern (2013) from Weiner (1985 & 2010).


Appendix 7: Dejoy’s (1994) Attribution Model of SafetyManagement Process.

1 an exploration of accident/failure attributions and … · the fundamental attribution error, the...

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