Yang Yi, Liu Huaping, Sherwood Gwen D
Peking Union Medical College, School of Nursing, China.
The University of North Carolina at Chapel Hill, School of Nursing, NC, USA.
Int J Nurs Sci. 2021 Sep 7;8(4):444-452. doi: 10.1016/j.ijnss.2021.08.001. eCollection 2021 Oct 10.
Near misses happen more frequently than actual errors, and highlight system vulnerabilities without causing any harm, thus provide a safe space for organizational learning. Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes. This study aimed to explore frontline nurses' perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.
A qualitative exploratory study design was employed. This study was conducted in three tertiary hospitals in east China from June to November 2015. Purposive sampling was used to recruit 19 frontline nurses. Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan's 4I Framework of Organizational Learning as a coding framework.
Second-order problem solving behavior, based on the 4I Framework of Organizational Learning, was referred to as being a leader in exposing near misses, pushing forward the cause analysis within limited capacity, balancing the active and passive role during improvement project, and promoting the continuous improvement with passion while feeling low-powered.
4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses' role in promoting organizations to learn from near misses. In this study, nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving. However, additional knowledge, skills, and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.
险些失误比实际差错发生得更频繁，且能在不造成任何伤害的情况下凸显系统漏洞，从而为组织学习提供一个安全空间。二阶问题解决行为提供了一个新视角，有助于更好地理解护士如何促进从险些失误中学习以改善组织成果。本研究旨在探讨一线护士对于运用二阶问题解决行为从险些失误中学习以提高患者安全的看法。
采用定性探索性研究设计。本研究于2015年6月至11月在中国东部的三家三级医院开展。采用目的抽样法招募了19名一线护士。使用克罗斯安的组织学习4I框架作为编码框架进行半结构化访谈和定性定向内容分析。
基于组织学习4I框架的二阶问题解决行为被认为是在暴露险些失误方面发挥引领作用、在有限能力范围内推动原因分析、在改进项目中平衡主动和被动角色以及在感到力量不足时仍满怀热情地促进持续改进。
组织学习4I框架可作为一项潜在指南，以丰富一线护士在促进组织从险些失误中学习方面的作用。在本研究中，护士通过运用二阶问题解决在组织从险些失误中学习方面发挥了关键作用。然而，在识别出险些失误时，需要额外的知识、技能和支持来最大限度地应用二阶问题解决行为。
