Davis Leigh, Ware Robert, McCann Damhnat, Keogh Samantha, Watson Karen
School of Nursing, Queensland University of Technology, Brisbane, Australia.
J Adv Nurs. 2009 Jun;65(6):1293-9. doi: 10.1111/j.1365-2648.2009.04990.x. Epub 2009 Apr 3.
This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice.
Medication administration is a complex aspect of paediatric nursing and an important component of day-to-day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance.
A cross-sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%.
Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0.001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0.001), including choosing between following policy and acting in the best interests of the child (P = 0.002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0.01). Less experienced nurses reported greater confidence with computer literacy (P < 0.001).
Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.
本文报告一项研究，旨在探讨预先确定的情境主题（与工作环境和社交相关）对护理用药实践的影响。
给药是儿科护理中一个复杂的方面，也是日常护理实践的重要组成部分。人们正在做出许多努力来提高患者安全，但仍存在许多错误。识别和理解影响给药错误的因素至关重要。
2004年，对澳大利亚一家三级儿科医院急诊科、重症监护病房以及内科和外科病房的278名儿科护士进行了横断面调查。回复率为67%。
情境影响在决定用药政策的遵循程度方面很重要。185名护士（67%）返回了完整的问卷。年龄小于34岁的年轻护士认为，与她们一起核对药物的人会影响她们的给药实践（P = 0.001），并且在某些日常情况下，不严格遵守用药政策是可以接受的（P < 0.001），包括在遵循政策和为孩子的最大利益行事之间做出选择（P = 0.002）。资深护士一致认为，资深员工通过榜样作用决定了用药政策的可接受遵守水平（P = 0.01）。经验不足的护士报告称对计算机知识更有信心（P < 0.001）。
组织需要采用多学科教育项目，以促进对用药政策的普遍理解和遵守。应密切监测技能组合，以确保为新员工和初级员工提供足够的支持。
