An analysis of the factors of medical errors perceived by nurses : Factor exploitation and model construction
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概要
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[原著] In order to identify the factors that nurses having experienced medical errorsconsidered likely to lead to medical errors and to find out the inter-relations amongfactors and explain their perception formation by model construction, we surveyed1,053 nurses who were working in eight randomly-selected hospitals each havingmore than one clinical department. We conducted exploratory factor analysis to find out a small number of latentbackground factors from a large number of items that are manifest factors, and alsoused Structural Equation Models. For the identification of factors, 23 items wereinput to extract factors by factor analysis; multiple linear regression analysis wasapplied. Data analysis used for factor analysis and multiple linear regressionanalysis; moreover SEM which is able to show cause and effect relations inphenomena and concept structures, was used. As the result of verifying the independence between the years of nursingexperience with five years set as the separator and the experience or nonexperienceof medical accidents by the Chi-square test showed a significantdifference between nurses with less than five years and nurses with five years ormore of experience. With less than five years of experience working as a nurse, fivefactors of “Poor physical conditions,” “Unable to concentrate,” “Inferior workingenvironment,” “Tasks which easily lead to confusion,” and “Looking- Back” wereextracted from nurses, while the four factors of “Management of health,” “Variantservices,” “Difficult judgment,” and “Demotivation” were extracted from nurseswith five years or more of experience working. In the adopted models, factors are divided into ones associated with the individualaspects of a nurse and ones associated with working environments. In both modelsfor nurses with or without at least five years of experience, a cause-and-effectrelation is drawn from factors associated with working environment through tofactors associated with personal aspects. It was presumed that nurses with lessthan five years of experience perceived the factors of medical errors to lie in thevery working environment in which they were working, while nurses with fiveyears or more of experience perceived medical errors to be attributable tointerpersonal relations. It is important to, based on the results of this study, notonly attempt to improve the work environment and interpersonal relations but alsobe thoroughly committed to the creation of smooth relationships. 本研究は、医療事故または過誤経験のある看護師を対象に、看護師の医療事故または過誤に対する意識を探索することにより、その要因の特定と要因間相互の関連性およびその構造をモデル作成によって説明することを目的にする。 方法は、潜在的な要因を探索的因子分析を用いて見出し、その背後にある要因の関係は、共分散構造分析（SEM）を用いて示した。対象は中部、中国地方から医療事故または過誤防止のための対策を講じている複数診療科をもつ８病院を選定し、そこに勤務する看護師に行った。有効回答数は１０５３名であった。データの解析には因子分析と重回帰分析を行い、さらに現象や構成概念の因果関係を示す共分散構造分析を用いた。 結果、看護師経験５年未満と以上の医療事故の意識に有意差が見られた。５年未満は心身不調、集中不可能、労働環境不良、錯誤業務、振り返りが抽出され、５年以上は体調管理、業務変動、状況判断不能、士気消失が抽出された。モデルは、５年未満、５年以上とも労働環境から個人要因に関わる要因に因果関係が導かれ、５年未満は、自分の働く労働環境そのものに、５年以上は対人関係に医療事故または過誤の要因のあると意識していた。本結果をふまえ、職場環境の改善や人的交流を図り、スムーズな人間関係作りを徹底して行うことが重要であることが示唆された。
- 2011-01-04