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Nurses’ perception of intensive care and the factors in errors

Organizational factors One of the themes extracted from the interviews was organizational factors. The participants’ perception of the organizational factor revealed factors like educational nature of organization, provision of general services, understaffed wards, work shifts, crowded wards by patients, heavy workload, and absence of a codified education program as the underlying causes of errors. These factors were categorized as organization management, organizational specification, and educational organization. Organization management Many of the participants mentioned that understaffed wards and consecutive work shifts not only adds to physical problems of nurses but also degrades their ability and accuracy in providing cares, which leads to higher error rate. “I think, heavy and intense work shifts are one of the causes of errors. Take me for example, I’ve been at work for 18hrs since yesterday afternoon. An ICU staff should not work like this and then expect them to provide ideal care service without errors.” (P8) Organizational specifications The majority of participants stated that organizational specifications such as educational organization, provision of general services, and using inexperienced staff in ICU contributed to error occurrence. According to the participants’ perception, educational nature of the organization brings trainees and students at different levels to the hospital. In addition, inexperienced nurses are recruited in the ICU. These add to the risk of errors. “State hospitals are educational where students practice clinical skills. This adds the risk of error. There are also inexperienced forces who are not oriented with a high risk of error. We even have had drug errors that had led to death.” (P7) Educational organization Another underlying concept was negligence in providing an environment to improve staff’s care knowledge and skills. Lack of in-service education program, lack of evidence-based education, and lack of a codified educational system were the underlying factors in error occurrence. “Nobody commits medical errors intentionally. I think lack of in-service education is one of the causes of medical errors by nurses. Those few educational programs are of low quality; I mean, they are not evidence-based.” (p11). ICU factors According to the participants, the ICU has unique specifications that might prepare the ground for medical errors. There were two categories in this theme viz. patients’ traits and environmental specifications.