护士无惩罚制度下护理不良事件上报意愿及原因分析

Reason Analysis of Nurses Intention of Adverse Events Report under No Punishment Policy

目的了解护士无惩罚制度下护理不良事件的上报意愿及原因。方法 2013年8-10月,采取便利抽样的方法,以成都市某三级甲等综合性医院有护士执业证书、工作2年以上的临床护士为调查对象,采用自行设计的问卷进行调查,包括无惩罚制度下护士主动上报护理不良事件的意愿及阻碍护士上报不良事件的因素。结果 (1)当不良事件可以隐瞒时、不能隐瞒时及介于两者之间时,有上报意愿人员的比例分别为4.65%、95.41%和35.27%;(2)阻碍护士上报不良事件前5位的因素是未对上报者和事件当事人保密、上报过程过于复杂、责备文化、无惩罚制度的实质没有充分体现、害怕承担责任;(3)不同职务及工龄护士的上报意愿差异有统计学意义(P<0.05)。结论无惩罚制度下,护士上报不良事件的意愿仍较低,且不同职务及工龄护士的上报意愿有差异;而众多因素可阻碍护士上报不良事件。

Objective To investigate the nurses＇ intention of adverse events report under no punishment policy and its influence factors.Methods By convenience sampling,clinical nurses with more than 2years of working experience in Class III Grade I hospital and with nurse license were selected and investigated by using self-designed questionnaire including nurses＇ intention of adverse events report under no punishment policy questionnaire and influencing factors of unwillingness of adverse events report even under no punishment policy.Results ①In the situation that adverse events can be concealed,only4.65% of nurses in this situation tended to report;In the situation that adverse events cannot be concealed,95.41% tended to report;Except for the situation that can be concealed and cannot be concealed,the total report rate was 35.27%.②The top five factors impeding nurses to report adverse events were：without confidentiality to the reporter and party;the procedure to report adverse events were too complicated;blame culture;the essence of unpunished report system were not fully embodied;afraid to take responsibility.③There were statically significance of report intention between nurses with different job titles and working years（P〈0.05）.Conclusion The nurses had a low intention to report adverse events even under no punishment policy,and there were statistically significance of report intention between nurses with different job titles and working years and many factors could impeding nurses to report adverse event.