Elfering Achim, Grebner Simone, Ebener Corinne
a Psychology , University of Bern , Bern , Switzerland.
Psychol Health Med. 2015;20(2):139-47. doi: 10.1080/13548506.2014.913796. Epub 2014 Apr 30.
Errors are frequent in health care. A specific model was tested that affirms failure in cognitive action regulation to mediate the influence of nurses' workflow interruptions and safety conscientiousness on near-accidents in health care. One hundred and sixty-five nurses from seven Swiss hospitals participated in a questionnaire survey. Structural equation modelling confirmed the hypothesised mediation model. Cognitive failure in action regulation significantly mediated the influence of workflow interruptions on near-accidents (p < .05). An indirect path from conscientiousness to near-accidents via cognitive failure in action regulation was also significant (p < .05). Compliance with safety regulations was significantly related to cognitive failure and near-accidents; moreover, cognitive failure mediated the association between compliance and near-accidents (p < .05). Contrary to expectations, compliance with safety regulations was not related to workflow interruptions. Workflow interruptions caused by colleagues, patients and organisational constraints are likely to trigger errors in nursing. Work redesign is recommended to reduce cognitive failure and improve safety of nurses and patients.
医疗保健中的差错屡见不鲜。我们测试了一个特定模型，该模型确认认知行动调节失败会介导护士工作流程中断和安全意识对医疗保健中险些发生的事故的影响。来自瑞士七家医院的165名护士参与了问卷调查。结构方程模型证实了假设的中介模型。行动调节中的认知失误显著介导了工作流程中断对险些发生的事故的影响（p < 0.05）。通过行动调节中的认知失误从意识周到险些发生的事故的间接路径也很显著（p < 0.05）。遵守安全规定与认知失误和险些发生的事故显著相关；此外，认知失误介导了遵守规定与险些发生的事故之间的关联（p < 0.05）。与预期相反，遵守安全规定与工作流程中断无关。由同事、患者和组织限制导致的工作流程中断很可能引发护理差错。建议重新设计工作流程以减少认知失误并提高护士和患者的安全性。
