Always having to say you're sorry: an ethical response to making mistakes in professional practice

Efforts to decrease errors in health care are directed at prevention rather than at managing a situation when a mistake has occurred. Consequently, nurses and other health care providers may not know how to respond properly and may lack sufficient support to make a healthy recovery from the mental anguish and emotional suffering that often accompany making mistakes. This article explores the conceptualization of mistakes and the ethical response to making a mistake. There are three parts to an ethical response to error: disclosure, apology and amends. Honesty and humility are discussed as important virtues that facilitate coping and personal growth for the health care provider who is involved in mistakes. In conclusion, a healthy view of nursing practice and mistake making is one that prevents error but, when prevention is not possible, accepts fallibility as part of the human condition and achieves the best possible outcome for all.     

Alternating training approach: comparative study of faculty education at the faculty training college and nurses' education

The hypothesis of this essay asserts that sandwich courses which are the object of this study in the framework of vocational training in the I.S.F.I. (nurses' school) and I.U.F.M (teacher training), will pertain to an educational logic if it facilitates the construction of the link between theory and practice, the emergence of practice knowledge, the construction of professional skills and if it enables the student to have access to a form of professional socialization. Today, the device lacks coherence and efficiency, there is not much time devoted to analysis and concentration. The presence of more performing trainers, involved in a real partnership would be necessary as well as the reorientation of these training on the professional skills. However, the sandwich courses help the students to distance themselves from practice and enable them to live through their own experiences. The study of the characteristics of these two training enables to make proposals aiming at improving the existing situation: they concern the development of new pedagogical methods, the creation of adapted tools, the improvement of the existing partnership and the training of the trainers.     

Toward a Theory of Self-Reconciliation Following Mistakes in Nursing Practice

PURPOSE: To explore nurses' responses to making mistakes in hospital-based practice in the US. METHODS: A grounded theory approach was used to explore the process that occurs after nurses perceive that they have made mistakes in practice. Theoretical sampling was used and data were collected until saturation occurred. Ten participants, who were registered nurses, described 17 personal mistakes. The mistakes they described occurred in hospitals. All participants were practicing nursing either in hospitals or in other work settings. FINDINGS: A process of "Self-Reconciliation After Making Mistakes in Hospital Practice" was identified, with four distinct categories: reality hitting, weighing in, acting, and reconciling. The core category was reconciliation of the self, personally and professionally. CONCLUSIONS: This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested.     

Nursing errors and the consequences. Results of a survey of nurses from inpatient care institutions

Internationally, research on the consequences of errors caused by nurses is quite comprehensive. In contrast, the body of knowledge on the effects that errors have on the nurses themselves is rather small. It is well known that errors can have profoundly negative outcomes on nurses. In some cases, however, errors can have useful ramifications. This paper shows the research results of a representative cross-sectional survey that covers 1,100 nurses working in German hospitals and nursing homes and illustrates the effects of errors on them. Most participants in the sample mentioned feelings of regret/remorse and irritation/annoyance/stress as an effect when they made a mistake. More than half of the nurses state that they also learnt from their errors. Hospital nurses frequently suffer from psychological effects while nursing home nurses experience more often professional or legal consequences. With increasing age and professional experience the nurses indicate a lower error impact. The answers given by nurse assistants differ from those of nurses with a three-year training course. The results suggest an amount of stress that may reduce efficiency and increase susceptibility to mistakes and which, therefore, needs to be remedied.     

Evaluation of nursing students' training in medical law

There is no co-ordinated focus on liabilities arising from nurses' medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients' rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students' training in their legal liabilities. The sample consisted of 309 students who were taking a course entitled 'Nurses' legal liabilities under Turkish criminal and civil law arising from medical interventions'. Data were obtained by means of self-administered questionnaires and McNemar's test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice.     

The three most common errors in family nursing: how to avoid or sidestep

In this article, the authors offer what they believe to be the three most common errors or mistakes in relational family nursing practice. Each error is described, followed by practical suggestions on how the mistake or error can be avoided. A clinical case vignette for each error is also given, with useful ideas of how the mistakes could have been avoided or sidestepped. By sidestepping and avoiding the most prevalent mistakes, nurses can not only sustain but also improve their nursing care of families and thus prevent unnecessary anguish and suffering of family members and possible shame, guilt, or embarrassment on the part of the nurse.     

SHEL模式在外科护理差错防范中的应用

护理差错的发生是多因素的。在外科护理管理过程中,应用SHEL(S-soft:软件部分,H-hard:硬件部分,E-environm ent:临床环境,L-litigant:当事人及他人)模式加强护理差错防范,从提高护士综合素质,改善工作环境,加强关键人员、工作制度、重点工作时段控制以及对重点病人的护理管理,制定行之有效的防范措施。经过2年的实践,使13个外科科室护理差错发生率明显下降,病人对护理工作的满意度提高。     

护理标识在神经外科重症监护室中的应用

目的探讨护理标识在神经外科重症监护室中的应用效果。方法本院神经外科重症监护室于2009年1-12月采用护理人员标识、病人身份标识、血型标识、管道标识、药物标识、提示标识应用于护理实践中。实施后1年内了解护理工作差错发生率及病人满意度。结果应用护理标识1年中发生护理差错2次,占0.2%,病人对护理工作满意度为98.5%。结论护理标识在神经外科重症监护室中应用,增强护士风险意识,提高护士工作的有序性及警惕性,减少了差错、意外事件的发生,提高了护理质量。     

Nurses' medication errors

This paper reports on a qualitative study of nurses' experiences with medication errors. Using discourse analysis within a framework of an interpretive research design, the phenomenon of a not too uncommon occurrence in nursing practice was examined. Insight into nurses' involvement with medication errors was gained from interviews, group discussions and self-reports. Documents of disciplinary proceedings, where the Professional Conduct Committee of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting has dealt with incidents of medication errors, supplemented the data. Decisions made in situations of medication errors have moral implications at personal, institutional, and professional levels. The moral courage that is needed to learn from mistakes can be enhanced through honest dealings with the situation. Where the attention is shifted from the person involved onto the problem at hand, fair judgement may be advanced and the fear of owning up to a mistake be diminished. Only when reflected upon, can personal experience merge into the stream of development and progress. This study contributes to such reflection. Three key issues are discussed in-depth as they evolved during analysis of the data: These issues deal with identification and change; with guilt and shame and the reconciliation with human precariousness; and with teaching and learning. The manner in which discourse analysis was used here represents an innovative attempt to advance qualitative methodology in nursing research.     

护理风险管理机制在护理质量管理中的应用

目的 探讨将护理风险管理机制运用于护理质量管理中的应用效果,防范或减少护理风险的发生,以提高护理质量.方法 分析可能引起护理风险的相关因素,建立完善的风险管理制度,制订风险防范措施,进行全员培训,强化风险意识,提高风险防范能力.结果 实施护理风险管理后护理质量控制效果均较实施前有所提高,经统计学分析,均P＜0.05,差异具有统计学意义.结论 将风险管理机制应用于护理质量控制中,减少了护理差错事故的发生,有效地提高护理质量.     

临床护理教学中预防护生发生差错事故的做法与体会

目的预防护生发生差错事故。方法抓好护生临床实习每个阶段的教育和技术培训,即:岗前防范教育、岗前技术培训、在岗教育、实习末期教育。结果增强了护生法律意识和安全意识,提高了护生自身素质和各项技术操作水平,以零差错事故率完成临床实习任务。结论抓好护生实习每个阶段的教育和技术培训,是防止护生差错事故发生的有效对策。     

护理事故差错原因的“冰山角”模型分析

目的 对护理事故差错原因进行表面原因、过渡原因和根本原因的分类,便于提出对策.方法 采用文献查询法和头脑风暴法,提出护理事故差错的原因,合并雷同原因,使用“冰山角”模型进行分类分析.结果 责任心不强、工作负荷大、职业作风不严谨、监督机制欠缺、护理人员配置不足为根本原因,医疗缺陷为表面原因,其余为过渡原因.结论解决护理事故差错的关键是加强责任心的培养,形成严谨的职业作风;配置充足的护理人员,减轻护理人员工作负荷;完善监督机制,加强监督.     

减少住院病人医疗收费差错的护理管理

目的减少医疗收费差错，提高住院病人满意度。方法针对发生的收费差错，采取人员培训、追踪检查结果、加强医嘱核对和费用审核、实施一日清单、公示收费标准等措施，并比较实施前后收费差错的情况。结果实施前收费差错率为71．67％，实施后为2354％，实施前后比较差异具有统计学意义。实施后病人对收费满意度提高。结论针对收费差错原因，实施各种改进措施，可以减少医疗收费差错。     

2型糖尿病患者饮食治疗存在的误区及护理干预

目的 探讨糖尿病患者饮食治疗存在的误区及护理干预效果。方法 采用自行设计的饮食治疗知识调查表,评价100例住院2型糖尿病患者饮食治疗存在的误区,并实施饮食护理教育、评价教育干预效果。结果 有40％左右的患者对糖尿病综合治疗中的作用、每日机体所需的七大营养要素、甜味剂的使用、膳食纤维的食用、当舍并糖尿病肾病时蛋白质的撮入量、每日盐的食用量、水果的食用、花生、瓜子的食用及对食品交换表的认识均存在不同程度的认识不足及错误。糖尿病教育明显提高患者的饮食治疗知识水平（P〈0．01）。结论 糖尿病患者饮食治疗存在较多误区,饮食教育千预使患者走出误区,明显提高患者的饮食治疗知识水平。     

低年资护士护理差错剖析与对策

目的客观分析低年资护士发生护理差错的特性，最大限度降低护理不安全隐患，进一步提高护理工作质量。方法对我院2004--2007年4年期间，低年资护士所引发的护理差错进行回顾性分析，就护理差错的发生时间、主要责任人特点、事件发生类型和发生原因4个主要方面进行深入探讨。结果上午9：30～11：30低年资护士护理差错发生的比例最高，占20．76％；在相关护理差错中，工作年限≤1年的护士为主要责任人群；由未规范核对所致的药物注射错误是低年资护士发生护理差错的主要类型。结论建议结合个人观与系统观，通过加强教育、优化管理等措施，培养低年资护士规范操作意识，养成规范操作的习惯，形成规范操作氛围，以期降低相关护理差错发生率。     

护生错误或习惯动作与护理技能形成的相关性分析

目的 研究护生错误或习惯动作与护理技能形成的相关性,帮助学生确认护理技能形成过程中的主要行为障碍,为教师制定因人而异的教学计划提供科学依据。方法 在美学礼仪训练课程前后、基础护理技能训练前后,采用规定动进行现场演示考核,将考核结果运用统计学方法进行分析,找出护生错误或习惯动作与护理技能学习或形成的相关性。结果 护生错误或习惯动作与护理技能的形成有相关性（P〈0．05）,其相关性的大小与习惯动作的纠正难度和训练时间成正比。结论 通过纠正护生错误或习惯动作对护理技能的形成和标准化有积极的促进作用,对增强护生的自信心、减轻心理压力有非常重要的作用。     

'To save the honour of thinking': a slightly petulant response to Griffiths

This is a response (a reply? a riposte?) to Peter Griffiths (Int. J. Nurs. Stud., in press, ) that attempts to answer some of the charges, which he levels at our book 'Deconstructing Evidence-based Practice' (Routledge, London, 2004). It begins by countering Griffiths' mistaken assertion that, in deconstruction, 'anything goes'. It argues that Griffiths is wrong because he has literally mistaken the meanings of certain words; that is, he has taken them wrongly. His biggest mistake, on which all of his others rests, is to mistake the word 'deconstruction' to imply a form of extreme relativism in which there are no right or wrong readings. In this, he is simply wrong. He is wrong in his assumption that there are no wrong readings, and the fact (yes, fact) that he is wrong demonstrates that some readings can be wrong. In particular, he mistakes the word 'challenge' to mean 'deny', and the word 'authority' to mean 'legitimacy'. This is not simply our reading of what we took him to mean (which could, by our own argument, be mistaken). It is his reading and his writing, there on the page in black and white. And this misreading, this mistake, inevitably leads him to a wrong conclusion. Having clarified the small matter that, in deconstruction, anything does not go, and that deconstructionists are not constrained to accept everything that is written about them, we then attempt to point out some other mistakes in Griffiths' non-review. Most importantly, we reject Griffiths' accusation that postmodernism is a strategy to 'save us from thinking' and instead, with Lyotard, advocate it as an attempt 'to save the honour of thinking'.     

中日基础护理教育模式的探讨

目的 分析日本大分医科大学护理学院基础护理训练与我国基础护理培训的现状,了解国内外护理学院基础护理培训的情况,探索护生培训模式.方法 以中日两国对护生培训的认识和方法进行对比,探讨从护理学院开始进行系统基础护理培训的方向.结果 基础护理关系到患者切身利益,护士必须履行对患者的基础护理职责,扎实做好基础护理工作,努力提高基础护理质量,逐步解决依赖患者家属或者家属自聘护工承担患者生活护理的问题,减轻患者的家庭负担.结论 通过考察对比.在保持各自个性特点的同时,取长补短,让护生在学校期间就能对做好基础护理服务有很强的意识,练就扎扎实实的基本技术,做好基础护理工作,使护士回到患者身边,为患者提供安全、有效、方便、满意的护理服务.     

行动研究法在护士科研能力培训中的应用

目的 探讨护理人员科研能力现状及科研培训存在的问题,在行动中培训护理人员科研能力,构建护理科研培训课程体系。 方法 采用行动研究法,在明确问题后,对45名在职护士分3期,每期15名,通过计划、行动、观察、反思3个循环过程实施护理科研培训;通过小组访谈、自我评价等收集资料发现问题,改进培训课程。 结果 研究对象各次课程的平均成绩均高于培训前,3轮培训同一课程平均成绩逐步提高,差异均有统计学意义（P<0.05）;各轮研究对象的整体平均成绩也逐渐提高,比较3个循环学员平均成绩,差异有统计学意义（F=48.481,P<0.001）。 访谈资料分析显示学员学习兴趣和学习自主性提高。 结论 行动研究法提高了护理科研培训效果, 构建了科研培训课程体系。