Aydon Laurene, Hauck Yvonne, Zimmer Margo, Murdoch Jamee
Neonatal Clinical Care Unit, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia.
Department Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia.
J Clin Nurs. 2016 Sep;25(17-18):2468-77. doi: 10.1111/jocn.13277. Epub 2016 Jun 6.
The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit.
Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question.
A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview.
One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'.
Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team.
The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to appropriately question aspects around medication administration.
本研究旨在确定在新生儿临床护理单元背景下，影响护士对用药管理方面提出质疑的因素。
新生儿护理中的用药错误率可能较高，因为这一群体特别脆弱。作为负责用药管理的护理人员，护士被认为应对大多数错误负责。然而，他们被视为预防工作的前沿力量。关于用药管理的推理、决策和质疑方面的证据极少。因此，本研究着重解决护士认为影响其质疑决策的知识空白。
采用关键事件设计，要求护士描述围绕其对用药问题提出质疑的临床事件。从新生儿临床护理单元招募护士，并让他们参加个人数字录音访谈。
2013年12月至2014年8月期间，有103名护士参与。使用持续比较法揭示了笔录中的共性。36个类别被归为三个主要主题：“工作环境”、“做正确的事”和“药物知识”。
研究结果突出了影响护士对用药管理问题提出质疑的因素。护士认为做正确的事并为弱势患者发声以提高患者安全是他们的责任。这些主题中的负面因素将为改善患者安全的教育策略规划提供参考，而正面因素则必须在多学科团队中得到强化。
工作环境必须支持护士提出质疑并最终提供安全的患者护理。清晰且最新的政策、正式和非正式教育、资深护士的榜样作用、有效运用沟通技巧以及团队协作方法，都可以促进护士适当地对用药管理方面提出质疑。
