The Effects of Contextual and Structural Factors on Patient Safety in Nursing Units

護理單位背景及結構對病人安全的影響

洪嫦巧(Chang-Chiao Hung) ； 許素珍(Su-Chen Hsu) ； 李來涼(Lai-Liang Lee) ； 黃秋綿(Chiu-Mien Huang)

《The Journal of Nursing Research》 21卷3期 (2013/09) Pp. 225-234

https://doi.org/10.1097/JNR.0b013e3182a0b004

摘要

背景：目前探討造成病人安全的原因，仍多著重於個人層級的探討而非組織層級。目的：本研究以一組織理論為基礎，探討組織的鉅觀因素對病人安全的影響。方法：本研究以「結構權變理論」為基礎，採橫斷性、自填問卷方式，以64個住院單位的護理長及護理人員為收案對象，以Tailored Design Method方式收集資料，收案期間為2010年12月至2011年2月。問卷進行資料集縮（data aggregation）之後，以AMOS軟體進行路徑分析並完成整體模式的估計。結果：本研究共計回收62份有效護理長問卷（98%）及977份護理人員問卷（72%）。資料集縮結果顯示，個人層級量表適用於單位層級之分析。路徑分析結果顯示，高專業自主程度、高護理專家比率、及具重症加護特性的護理單位，其給藥錯誤率也高。此外，單位技術性複雜的護理單位，也間接的造成高給藥錯誤率和病人跌倒率。結論與應用：研究結果顯示，組織鉅觀因素（包括組織背景及結構因素）確實對護理單位病人安全有影響。依據組織背景及結構因素的影響，調整在職教育內容、鼓勵護理人員參與病患安全訓練、及瞭解單位組織特性等，為建議提升病患安全的策略。

關鍵字

病人安全 ； 結構權變理論 ； 給藥錯誤 ； 病人跌倒 ； tailored design method

並列摘要

Background: Because of limited research on patient safety from a macrolevel perspective, our understanding of how to reduce the risk of system failures that impact patient safety outcomes in Taiwanese healthcare organizations is limited.Purpose: We conducted this study to explore the relationships between macrolevel factors and patient safety outcomes.Methods: Structural contingency theory was used as the framework for the study. A cross-sectional design was used, and data were collected from self-administered questionnaires. Head nurses and registered nurses working in 64 in-patient nursing units at three hospitals participated in the study. A tailored design method was used for data collation, and the data collection lasted 3 weeks during the winter of 2010. Data were aggregated from the individual to the unit level, and path analysis was used to examine the hypothesized model.Results: Sixty-two head nurses (96.8%) and 977 staff nurses (72%) completed and returned the questionnaire. Eta-squared coefficient (ŋ^2), interitem consistency (rwg), and F ratio results showed that data at the individual level are appropriate for aggregating to the unit level. These findings show that nursing units with high degrees of professional autonomy, comparatively higher proportions of nursing experts, and relatively large unit sizes tend to have higher rates of medication errors. In addition, we found high degrees of unit technology associated with higher rates of medication errors and patient falls.Conclusions/Implications for Practice: These findings suggest a link between macrolevel factors and patient safety outcomes. This study shows that redesigning continuing education programs encourages nurses to participate in patient safety training and understand the nursing unit characteristics that enhance patient safety outcomes to improve the patient safety of nursing units.

並列關鍵字

patient safety ； structural contingency theory ； medication errors ； patient falls ； tailored design method

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