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系統識別號 U0026-1502201614263700
論文名稱(中文) 探討急診室新進與資深護理師對醫療異常事件之知覺差異以設計訓練介入
論文名稱(英文) Studying Perceptual Differences of ER Medical Errors among Novice/Experienced Nurses for the Identification of Training Interventions
校院名稱 成功大學
系所名稱(中) 工業設計學系
系所名稱(英) Department of Industrial Design
學年度 104
學期 1
出版年 104
研究生(中文) 胡沛婕
研究生(英文) Pei-Chieh Hu
學號 P36011090
學位類別 碩士
語文別 英文
論文頁數 164頁
口試委員 指導教授-洪郁修
口試委員-陳清惠
口試委員-施欣怡
口試委員-賴新喜
口試委員-林明毅
中文關鍵字 醫療錯誤  急診部門  新進護理師  知覺差異  職前教育訓練 
英文關鍵字 medical errors  emergency department  novice nurse  perceptual differences  training intervations 
學科別分類
中文摘要 大型醫院急診部門有別於一般部門的醫療環境,即便在已受過專業化訓練的醫療團隊執行任務時,仍較其他部門存在著較高的醫療錯誤風險。其中,尤以新進護理師擁有較高的醫療錯誤發生率。過去文獻指出,超過半數的醫療錯誤皆為可防範的醫療錯誤為人為失誤所引起。針對人為錯誤,訓練為防範錯誤最有效率的方式之一,因此本研究試圖探索新進護理師與資深護理師對臨床上各類別錯誤事件的觀點,從兩者間的知覺差異進行分析、歸納與探討。藉由探索同類事件不同面向的觀點與解決方案,指出常見錯誤事件的關鍵環節,做為未來職前訓練改善方案的可能建議。
本研究採用質性研究方法,招募34位三所教學醫院急診部門護理師,參與半結構式訪談,參與者皆為女性,一共有資深護理師15位(平均年齡34歲,SD=5.06, 平均工作年資5年以上)、新進護理師19位(平均年齡24歲,SD=3,平均工作年資6至12個月)。研究結果整理出130件醫療錯誤事件,依序分為四種錯誤類別:給藥錯誤50例(48.5%)、檢查/檢體錯誤29例(28.2%)、儀器/管路設定與操作錯誤22例(21.4%),其他護理處置錯誤2例(1.9%)。
本研究結果顯示,在給藥錯誤事件中,資深護理師與新進護理師並無顯著的知覺差異。新進護理師與資深護理師一致認同新進護理師犯下給藥錯誤事件主要受技術為基準的行為與心理前兆影響。在檢查/檢體錯誤事件中,資深護理師與新進護理師亦顯著無知覺差異。新進護理師與資深護理師一致認同新進護理師犯下檢查/檢體錯誤事件主要受技術為基準的行為、規則為基準的行為與心理前兆影響。在儀器/管路設定與操作錯誤事件中,資深護理師與新進護理師有知覺差異。資深護理師認為影響主因分別為技術為基準的行為和規則為基準的行為兩種行為的失誤所造成。新進護理師則認為技術為基準的行為、知識為基準的行為可能造成錯誤發生。在其他護理處置錯誤事件中,由於本類別僅有新進護理師提出的錯誤事件,故無法比較雙方的知覺差異,新進護理師認為本類別的錯誤事件由技術為基準的行為、規則為基準的行為、知識為基準的行為三者所影響。本研究根據各類臨床錯誤事件給予相關建議,以期未來資深護理師與新進護理師相互合作,透過職前訓練,積極防範醫療錯誤的發生。
英文摘要 Unlike in other departments, professionally trained medical staff in emergency departments of large-scale hospitals are more prone to medical errors. Among medical staff, novice nurses bear a higher risk of medical errors. According to literature reviews, over half of medical errors are preventable human errors. In regard to this, training is by far one of the most effective ways to prevent human errors from occurring. Therefore, this study attempted to explore novice and experienced nurses’ views toward different kinds of medical errors and analyzed, summarized, and discussed differences in the degree of awareness among the two groups. By adopting different points of view and exploring possibilities, this study hoped to pinpoint key areas of some of the most common errors, thus providing suggestions for future pre-employment training for improvement.
Using a qualitative research approach, the study recruited 34 nurses from the emergency departments of three teaching hospitals to complete semi-structured interviews. All participants were female, 15 were experienced nurses (mean age=34, SD=5.06, average years of experience=5 or above), 19 were novice nurses (mean age=24, SD=3, average years of experience=6 to 12 months). The results showed a total of 130 medical errors classified into four types: 50 medication errors (48.5%), 29 checkup/collection errors (28.2%), 22 equipment-related errors (21.4%), and 2 other errors (1.9%).
The research results showed no significant difference between experienced and novice nurses regarding the degree of awareness about medication errors. Both groups unanimously agreed that medication errors committed by novice nurses were mainly caused by skill-based behavior and the presence of psychological precursors. Likewise, there was no significant difference between experienced and novice nurses regarding the degree of awareness about checkup/collection errors. Both groups unanimously agreed that checkup/collection errors were mainly caused by skill-based behavior, rule-based behavior, and the presence of psychological precursors. However, the degree of awareness among experienced and novice nurses about equipment-related errors varied. Experienced nurses believed that these errors were primarily caused by skill-based and rule-based behaviors, while novice nurses believed that they were caused by skill-based and knowledge-based behaviors. Regarding other errors that did not fall into any of the above classifications, since only novice nurses mentioned these errors, no comparison between the degrees of awareness could be made. Novice nurses believed that these kinds of errors were caused by skill-based behavior, rule-based behavior, and knowledge-based behavior.
This study has described the corresponding training strategies, content, and approaches according to different categories of medical errors, in the hopes of improving cooperation between experienced and novice nurses, and effectively avoiding medical errors via pre-employment training.
論文目次 摘要 ii
ABSTRACT iv
ACKNOWLEDGEMENTS vi
TABLE OF CONTENTS vii
LIST OF TABLES x
LIST OF FIGURES xii
CHAPTER 1 INTRODUCTION 1
1.1 Study background 1
1.1.1 Raising awareness about patient safety and medical error prevention 1
1.1.2 Medical errors in emergency department 1
1.1.3 Groups at high-risk for medical errors in the emergency department: novice nurses 2
1.2 Study motivation and the significance of the study 3
1.3 Study purpose and research questions 3
CHAPTER 2 LITERATURE REVIEW 5
2.1 Human error and medical error 5
2.1.1 Active errors 6
2.1.2 Latent errors 7
2.2 Perceptual difference 9
2.3 Nurse training in emergency department 10
2.3.1 Preceptors and clinical training 10
2.3.2 The other training aids 11
CHAPTER 3 METHOD 12
3.1 Participants 12
3.2 Research Procedure 14
3.3 Analytical Methods 16
3.3.1 Coding 16
3.3.2 Rules to identify active errors 16
3.3.3 Rules to identify latent errors 17
3.4 Research ethics 19
CHAPTER 4 RESULT 22
4.1 Overviews of errors events 22
4.2 Novice and experienced nurses’ perceptions of medication errors 29
4.2.1 Research findings on medication errors 29
4.2.2 Nurses’ perceptual difference of medication errors 37
4.3 Novice and experienced nurses’ perceptions of common collection/checkup errors 49
4.3.1 Research finding on common collection/checkup errors 49
4.3.2 Nurses’ perceptual difference of common collection/checkup errors 54
4.4 Novice and experienced nurses’ perceptions of equipment-related errors 63
4.4.1 Research finding on equipment-related errors 63
4.4.2 Nurses’ perceptual difference of equipment-related errors 67
4.5 Novice and experienced nurses’ perceptions of indistinguishable errors 73
4.5.1 Research finding on indistinguishable errors 73
4.6 Conclusion 75
CHAPTER 5 DISCUSSION 77
5.1 Active errors 77
5.2 Latent errors 83
5.3 Perception differences between the experienced and novice nurses 85
CHAPTER 6 RECOMMENDATION 87
6.1 Training strategies 87
6.2 Training content 87
6.2.1 Medication errors 87
6.2.2 Checkup/collection errors 90
6.2.3 Equipment-related errors 93
6.2.4 Other errors 93
6.3 Training approach 94
CHAPTER 7 CONCLUSION 95
7.1 Conclusion 95
7.2 Limitations of the Study 96
REFERENCES 99
APPENDIX 106
附件一 訪談大綱 106
附件二 國立成功大學醫學院附設醫院人體試驗委員會同意臨床試驗證明書 117
附件三 奇美醫療財團法人奇美人體試驗委員會同意臨床試驗證明書 118
附件四 高雄榮民總醫院護理部研究計畫評核表 119
附件五 受試者同意書 121
附件六 訪談內容逐字稿:給藥錯誤事件 126
附件七 訪談內容逐字稿:檢查/檢體錯誤事件 135
附件八 訪談內容逐字稿:儀器/管路設定與操作錯誤事件 142
附件九 訪談內容逐字稿:其他護理處置錯誤事件 150
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