Department of Sociology and Criminal Justice, Kennesaw State University, 1000 Chastain Rd., Kennesaw, GA 30144, USA.
Qual Health Res. 2010 Oct;20(10):1327-42. doi: 10.1177/1049732310372228. Epub 2010 Jun 7.
Despite many safeguards, nurses make the majority of medication administration errors. The purpose of our research was to investigate the perceived causes for such errors and to better understand how nurses deal with them. We performed an interpretive analysis of 158 accounts by nurses who made self-identified medication errors. We found common themes among these accounts. First, although nurses admitted responsibility for errors, they simultaneously identified a variety of external contributing factors. Second, nurses' accounts were often framed in terms of "being new," with the underlying background expectancy of inexperience. Third, emotionally devastating visceral responses to errors were common and often incongruent with error severity. Fourth, nurses had to deal with fear. Fifth, nurses voiced frustrations with technologies and regulations. Sixth, embedded within many of the accounts was a "lessons learned" theme, through which nurses developed "personal rules" as a result of an error. We conclude with suggestions for additional research.
尽管有许多保障措施，护士仍然是药物管理错误的主要责任人。我们研究的目的是调查这些错误的原因，并更好地了解护士如何处理这些错误。我们对 158 名自我报告药物错误的护士的陈述进行了解释性分析。我们在这些陈述中发现了一些共同的主题。首先，尽管护士承认对错误负有责任，但他们同时也确定了各种外部因素。其次，护士的陈述往往是基于“新手”的情况，其潜在的背景预期是缺乏经验。第三，对错误的情绪上的打击和痛苦的内在反应很常见，而且往往与错误的严重程度不一致。第四，护士必须面对恐惧。第五，护士对技术和法规感到沮丧。第六，许多陈述中都有一个“吸取教训”的主题，护士通过这个主题在错误后制定了“个人规则”。我们最后提出了进一步研究的建议。
