Incidents related to nursing and their main background factors

目的与方法：采用邮件调查的方法，从患者的基本愿望出发，从生活条件的角度了解医疗事件，并探讨影响个案发生的背景因素。研究对象为全国154所大学医院的护士（研究1）和35所护理学校的学生（研究2）。研究1采用自2001年9月1日起1个月内的37个护理项目，研究2采用6-7个月实习期的30个项目。结果：研究1共收到5304份有效回复（来自78家医院），其中5.2%报告了事故，0.98%报告了事故。高频率的问题包括“在共用病房治疗病人时无意中大声说话”（22.9%），“担心检查车发出噪音”（21.5%），以及“夜间查房时用手电筒照病人的脸”（15.4%）。64.3%的事故发生在白班，24.0%的事故发生在深夜，10.1%的事故发生在晚上。研究2有1176份有效回复（30所学校）。常见的事故是“海绵浴水温不合适”（42.4%）、“消毒不彻底”（39.7%）、“换体位后忘记更换床轨”（37.7%）和“测量血压时水银柱掉在床上”（37.7%）。在研究1中，造成事故的高风险是那些没有真正考虑他们护理行为的意义的人；性格粗暴、急躁或易怒的人；他们缺乏经验；在研究2中，那些没有真正考虑自己护理行为的意义或性格粗暴的人。讨论：个性与事件/事故有关，建议结合活动来帮助学生了解自己的个性并谨慎行事，将有效预防医疗事故

Purpose and methods :A mail survey was conducted to understand medical incidents from the viewpoint of living conditions based on patients' basic desires, and investigate the background factors contributing to individual cases. Subjects were nurses at 154 university hospitals nationwide (Study 1) and students at 35 nursing schools (Study 2). The incidents/accidents were measured by 37 nursing items for one month starting on September 1, 2001 for Study 1, and 30 items in the practical training period (6-7 months) for Study 2.Results:Study 1 had 5,304 valid responses (from 78 hospitals), of which 5.2% reported incidents and 0.98% accidents. High frequency items included "Inadvertently speaking louder than necessary when treating patients in a shared room" (22.9%), "worry about an examination cart that rolls noisily" (21.5%), and "shining a flashlight in patients' faces on night rounds" (15.4%). The incidents/accidents occurred on the day shift in 64.3% of cases, late night in 24.0%, and evening in 10.1%. Study 2 had 1,176 valid responses (30 schools). Common incidents/accidents were "inappropriate water temperature in sponge baths" (42.4%), "incomplete sterilization" (39.7%), "forgetting to replace bed rail after changing patients' positions" (37.7%), and "the mercury column falling over on the bed during blood pressure measurement" (37.7%). In Study 1, those with a high risk of causing an accident were those who did not really consider the meaning of their nursing actions ; who had a rough, impatient, or irritable personality ; who were inexperienced ; and who worked in internal medicine, and in Study 2 those who did not really consider the meaning of their nursing actions or had a rough personality.Discussion :Personality was related to incidents/accidents, and it is suggested that incorporating activities to help students understand their own personalities and act carefully would be effective in preventing medical accidents