Recommendations to prevent nursing errors: Content analysis of semi-structured interviews with intensive care unit nurses in a developing country.

AIM: To elicit intensive care unit (ICU) nurses' recommendations to prevent nursing errors. BACKGROUND: Errors are usually induced by faulty systems, and managers play a key role in building a safe health care system. METHOD: A qualitative research design was used. Semi-structured interviews with 112 Egyptian ICU nurses were conducted, and responses were analysed using qualitative content analysis. RESULTS: Responses from 108 nurses were analysed. Six themes of recommendations were identified: improvement and better organisation of resources, policy modification, education and training, likeness minimization, use of technology and work environment changes. CONCLUSION: Nurses' recommendations reflect the poor-resource context in developing countries. Several recommendations, however, are relatively cheap to implement strategies. IMPLICATIONS FOR NURSING MANAGEMENT: All reported recommendations are organisational issues. Improvement and better organisation of human and non-human resources is a priority issue to prevent or minimize nursing errors. Policy modification, education and training, and likeness minimization are relatively cheap, easy-to-implement strategies to tackle the occurrence of nursing errors in developing countries. Staff nurses should be actively involved in policy reform. Patient safety education should be supported by adopting modern technology and work environment reform.

Nature of nursing errors and their contributing factors in intensive care units.

BACKGROUND: Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety. AIM: To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs). METHODS: A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis. RESULTS: A total of 300 errors were reported. Most of them (94·3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84·3% of them. More errors occur during the evening shift than the night and morning shifts (42·7% versus 28·7% and 16·7%, respectively). There is a statistically significant relation (p ≤ 0·001) between error disclosure to a nursing supervisor and its impact on the patient. CONCLUSIONS: Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness. RELEVANCE TO CLINICAL PRACTICE: Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.