Study on Human Errors in the Fields of Nursing and Social Welfare

[项目1-1.对医疗和社会福利服务实践中人为差错的现状进行了调查[对护理事故报告中处理护理事故的方式和过程中采取的预防措施进行了分析和归类；指出了建立护理事故研究框架和统一术语的必要性。接下来，对符合新泻县护理保险法要求的项目从业人员的风险管理状况进行了调查。虽然已经采取了初步步骤来预防事故，但需要外部支持来制定有效措施来实现这一目标。[项目1-2.家访护理站风险管理现状调查[方法]对居家护理站进行调查，并对家访护理站护理人员进行焦点小组访谈。该研究阐明了影响ACCI…发生的背景因素更多与家庭护理有关的咬牙以及预防措施。[项目2-1.护理现场事故发生可能性与风险规避行为的主观判断[目的]调查护士在日常护理工作中对即将发生的事故的预感，以及对事故的行为选择、决心和预测。为了解释行为选择，新手护士的特点是接受更有经验的护士的意见，而那些更有经验的护士根据某些关键因素对安全性做出判断。在预测事故方面存在一些个体差异，但这种差异的背景无法确定[项目2-2]。[[中英文摘要]护理差错与基础护理教育--基础与实践、个体特征与外部因素]调查了5所不同机构的881名护士对与医疗行为有关的事故及事件发生因素的态度、认知、观察、判断、确认与事故发生的关系。[项目3.基础护理培训中的安全教育]对8名护士进行焦点小组访谈。一次事故发生后，护士的态度从紧张、焦虑、自卫转变为高度的自主感、信息共享，促进了专业间的合作。采用问卷调查法，对培养执业护士、内科医生、社会工作者和护理福利服务人员的四年制本科院校的事故预防培训情况进行调查。旨在预防事故的独立课程的数量有所增加，特别是在医学院。在护理大学，事故预防与其他不同的学科一起教授。[项目4.人为错误的示范结构和安全教育课程的构建]为了建立基于对人为错误和行为的结构分析的护理教育，以避免事故的发生，并将这种教育方法应用于实践，建议出版适当的教育材料和编制安全教育课程。较少

【Project 1-1. A survey on the status of human errors encountered in die practice of health care and social welfare service】 The manner of handling nursing-related accidents in reports on such accidents and preventive measures taken in the process were analyzed and classified ; and the needs to establish a framework for the topic of studies on nursing accidents and uniformity of terminology were indicated. Next, a survey was conducted on the status of risk management by those engaged in programs that meet the requirements the nursing insurance law in Niigata Prefecture. Although initial steps have been taken to prevent accidents, external support is needed to establish effective measures to accomplish this. 【Project 1-2. A survey on the status of risk management at home visiting nursing stations】 A survey on home nursing stations and focus group interviews of nursing personnel at these stations were conducted. The study clarified the background factors that affect the occurrence of acci … More dents related to home nursing and the measures that are needed to prevent them. 【Project 2-1. Subjective judgments on the possibility for accident development on the nursing scene and risk avoiding behavior】 A survey was conducted on the premonitions experienced by nurses on impending accidents while performing their daily nursing duties, as well as their behavior choices, determination, and accident predictions. To explain behavioral choices, novice nurses characteristically accept the opinions of more experienced nurses, while those nurses with more experience make judgments on safety based on certain key elements. There are some individual differences in predicting accidents but the backgrounds for such differences could not be ascertained 【Project 2-2. Nursing errors and basic nursing education-fundamentals and practices, individual characteristics, and external factors】 Accidents related to medical actions and factors responsible for the development of incidents were examined with 881 nurses in 5 facilities with different affiliations acting as the as attitude, recognition, observation, judgment, and confirmation by nurses were related to the occurrence of accidents. 【Project 3. Safety education in basic nursing training】 A focus group interview was conducted with 8 nurses. Following an accident, the attitudes of nurses were transformed from "tension and anxiety" and "self defense" to a "heightened sense of autonomy" and "sharing of information", promoting interprofessional cooperation. A survey by using questionnaires was conducted on the status of training for accident prevention at 4-year universities where licensed nurses, physicians, social workers, and nursing welfare service personnel are being trained. The number of independent courses intended for accident prevention has increased, especially at medical schools. In nursing universities, accident prevention is taught in association with other diverse subjects. 【Project 4. A model structure for human errors and construction of a curriculum for safety education】 To establish nursing education based on the structural analysis of human errors and behavior to avoid the development of accidents and to apply such an educational approach to practice, suggestions were made for the publication of appropriate educational materials and preparation of curricula for safety education. Less