Nursing Inquiry. 2019;00:e12298. wileyonlinelibrary.com/journal/nin | 1 of 8 https://doi.org/10.1111/nin.12298 © 2019 John Wiley & Sons Ltd 1 | INTRODUCTION Adverse health care events are defined as medical injuries caused by medical management, including all aspects of care, rather than by the patient's underlying disease. Adverse events have recently been estimated to be the 14th leading cause of morbidity and mortality in the world's population and are known to be a global public health issue (Jha et al., 2013; World Health Organization, 2005). Overall, one in 10 patients suffers from a hospital‐acquired condition, such as hospital‐acquired infections, pressure injuries, and falls (National Patient Safety Foundation, 2015). In Sweden, 12.3% of all admis‐ sions to hospitals are related to at least one adverse event, and esti‐ mates show that 7.5% of these could have been prevented (Swedish Associations of Local Authorities & Regions, 2018). The focus on patient safety, that is, ‘the reduction of risk of unnecessary harm as‐ sociated with health care to an acceptable minimum’ (World Health Organization & WHO Patient Safety, 2010, p. 15) and measures taken internationally to diminish suffering, the number of deaths, and costs to society have increased, particularly after the Institute of Medicine published the report To Err Is Human (Kohn, Corrigan, & Donaldson, 2000). However, patient safety efforts have not pro‐ gressed as quickly as anticipated and have recently been acknowl‐ edged to be a more complex area than expected, with large gaps in knowledge remaining globally (National Patient Safety Foundation, 2015; Pronovost, Cleeman, Wright, & Srinivasan, 2016; World Health Organization et al., 2008). How unsafe patient care is discussed and thought about depends on a diversity of contexts and perspectives, which creates opportunities for a diversity of actions, all of which Received: 10 December 2018 | Revised: 2 May 2019 | Accepted: 9 May 2019 DOI: 10.1111/nin.12298 FEATURE Written reports of adverse events in acute care—A discourse analysis Anna Gyberg 1,2 | Ingela Henoch 1,3 | Margret Lepp 1,4,5 | Helle Wijk 1,6,7 | Kerstin Ulin 1,2 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden 3 Angered Hospital, Gothenburg, Sweden 4 Østfold University College, Halden, Norway 5 School of Nursing and Midwifery, Griffith University, Brisbane Queensland, Australia 6 Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden 7 Center of Health Care Architecture, Chalmers University, Gothenburg, Sweden Correspondence Anna Gyberg, Sahlgrenska University Hospital, Diagnosvägen 11, 41685 Gothenburg, Sweden. Email: anna.gyberg@vgregion.se Funding information We are grateful to The Swedish Health Care Facilities Network and the foundation of Hjalmar Svensson, which have supported this study with grants. Abstract Adverse health care events are a global public health issue despite major efforts, and they have been acknowledged as a complex concern. The aim of this study was to explore the construction of unsafe care using accounts of adverse events con‐ cerning the patient, as reported by patients, relatives, and health care professionals. Twenty‐nine adverse events reported in an acute care setting in a Swedish university hospital were analyzed through discourse analysis, where the construction of what was considered to be real and true in the descriptions of unsafe care was analyzed. In the written reports about unsafe events, the patient was spoken of in three different ways: (a) the patient as a presentation of physical signs, (b) the patient as suffering and vulnerable, and (c) the patient as unpredictable. When the patient's voice was subordinate to physical signs, this was described as being something that conflicted with patient safety. The conclusion was that the patient's voice might be the only sign available in the early stages of adverse events. Therefore, it is crucial for health care professionals to give importance to the patient's voice to prevent patients from harm and not unilaterally act only upon abnormal physical signs. KEYWORDS adverse event, adverse health care event, discourse analysis, patient safety, unsafe care