Factors Contributing to Errors in Nursing Practice: A Case Study

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Abstract

Factors contributing to errors in nursing practice: A case studyBACKGROUND: Globally there has been growing concern regarding medically oriented errors arising in clinical practice; however, little is known about nursing errors, particularly within Saudi Arabia. Nursing errors are usually associated with medication errors with other types of error in nursing practice being poorly defined. This leaves a gap in the literature for further exploration to establish if a discrete category of error associated solely with nurses and nursing can be distinguished. There is evidence to suggest that nurses who are involved in clinically oriented errors are “named, blamed and shamed” despite international calls for non-punitive approaches to error management being advocated in healthcare settings. Aim and Objectives: This study aimed to investigate how and why nursing errors occurred in one healthcare organisation in Saudi Arabia. The study objectives included the need to identify the type of errors that occurred and how incidents were defined as errors, to examine the context and consequence of nursing errors and how these were managed in the organisation, and to explore how nurses perceived their role and that of the organisation in managing nursing errors.METHODS: A qualitative case study was carried out in one hospital in Saudi Arabia. Following a retrospective review of the preceding six-months incident report documentation, four groups of participants were purposively sampled from clinical wards within the hospital experiencing both high and low rates of error. Individual and focus group interviews were undertaken with nurses, doctors, nurse managers and quality department staff to generate a multi-perspectival review of the case. All the conducted interviews were transcribed verbatim, coded and analysed. The Swiss cheese model was used as an analytical tool to provide an explanation of the case by identifying the latent and active failures arising within the organisation.CONCLUSIONS: Analysis of the data revealed a level of ambiguity when defining what constituted ‘nursing error’. Yet defining and distinguishing nursing errors was crucial to help develop nursing as a profession. Furthermore, nurses, doctors, nurse managers and quality staff all perceived diverse latent failures contributed to nursing errors, notably the existence of different policies/protocols across hospital wards/units, different work systems and processes between hospital wards, the role of diversity related to the healthcare professionals’ cultural background, increased patient acuity and the presence of a blame culture. In essence therefore each of the above was seen to be key organisational factors leading to the manifestation of errors in clinical practice. Finally use of the Swiss Cheese Model helped identify that organisational as opposed to purely human influences were the main factors contributing to errors, by creating necessary the preconditions for unsafe acts to arise within the targeted organisation.

Keyword(s)

human factors, patient safety ; nursing errors

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