Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran.
J Nurs Manag. 2022 Mar;30(2):482-490. doi: 10.1111/jonm.13524. Epub 2022 Jan 25.
To assess systems thinking level and its relationship with occurrence and reporting of adverse events in Iranian nurses.
Systems thinking has recently emerged as an important element of patient safety and quality improvement in health care systems. It helps health care professionals to understand the different elements of health care systems, the interrelatedness and interdependencies of these elements in the health care systems.
This cross-sectional survey was carried out in 10 teaching hospitals in Tehran, Iran. A total of 511 nurses were selected using simple random sampling. Systems thinking was measured using the validated Systems Thinking Scale. Data analysis was performed by descriptive analyses, independent t test and logistic regression analysis.
The average score for total systems thinking was a mean of 49.45 (SD = 12.10; range 0-80). In total, 67.5% of participants reported the experience of the occurrence of adverse events leading to harm to patients, and 65.2% of them responded as having appropriate adverse events reporting behaviours. Nurses who had higher scores in systems thinking were found to be more likely to report adverse events (odds ratio = 1.07; 95% CI = 1.05-1.09), whereas they were less prone to experience adverse events (odds ratio = 0.97; 95% CI = 0.95-0.98).
Our results indicated that the nurses' systems thinking level was moderate. Systems thinking had a significant role in preventing the occurrence of adverse events as well as improving the reporting of adverse events. Therefore, it is recommended to enhance the competency of nurses' systems thinking to prevent the occurrence of adverse events and to improve the reporting of adverse events.
Nursing managers need to focus on the systems thinking weaknesses and the occurrence and the reporting of adverse events in policymaking, practice and research. Also, systems thinking should be integrated with the health care system for preventing the occurrence of adverse events and improving reporting of adverse events. They should support, lead and allocate the essential pragmatic strategies and resources for the involvement of all health care members in policymaking.
评估伊朗护士的系统思维水平及其与不良事件发生和报告的关系。
系统思维最近已成为医疗保健系统中患者安全和质量改进的重要组成部分。它帮助医疗保健专业人员了解医疗保健系统的不同要素、这些要素在医疗保健系统中的相互关系和相互依存关系。
本横断面调查在伊朗德黑兰的 10 所教学医院进行。采用简单随机抽样法共选取 511 名护士。使用经过验证的系统思维量表来测量系统思维。数据分析采用描述性分析、独立 t 检验和逻辑回归分析。
总体系统思维的平均得分为 49.45（SD=12.10；范围 0-80）。共有 67.5%的参与者报告了导致患者伤害的不良事件发生的经历，其中 65.2%的人表示有适当的不良事件报告行为。系统思维得分较高的护士更有可能报告不良事件（优势比=1.07；95%CI=1.05-1.09），而他们发生不良事件的可能性较小（优势比=0.97；95%CI=0.95-0.98）。
我们的结果表明，护士的系统思维水平处于中等水平。系统思维在预防不良事件的发生以及改善不良事件的报告方面发挥了重要作用。因此，建议提高护士的系统思维能力，以预防不良事件的发生和改善不良事件的报告。
护理管理人员在制定政策、实践和研究中需要关注系统思维的薄弱环节以及不良事件的发生和报告。此外，应将系统思维与医疗保健系统相结合，以预防不良事件的发生和改善不良事件的报告。他们应支持、领导并分配必要的实用策略和资源，让所有医疗保健成员参与制定政策。
