Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

Received: 12 September 2021 | Revised: 12 November 2021 | Accepted: 20 December 2021
DOI: 10.1111/jocn.16200
ORIGINAL ARTICLE
Occurrence of self-perceived medical errors and its related

influencing factors among emergency department nurses
Jing Wang PhD Student1 | Ketao Mu MD, Associate Chief Physician2 | Yanhong Gong PhD,
Associate Professor1 | Jianxiong Wu PhD Student1 | Zhenyuan Chen PhD Student1 |
Nan Jiang PhD Student1 | Guopeng Zhang MD, Associate Chief Physician3 |
Chuanzhu Lv MS, Professor4,5,6 | Xiaoxv Yin PhD, Associate Professor1
1
Department of Social Medicine and
Health Management, School of Public Abstract
Health, Tongji Medical College, Huazhong
Aims and objectives: To determine the prevalence and the associated factors of self-
University of Science and Teβchnology,
Wuhan, China perceived medical errors among Chinese emergency department nurses.
Background: The emergency department is a place with a high incidence of medical
2
Department of Radiology, Tongji
Hospital, Tongji Medical College,
Huazhong University of Science and
errors. Studies about the occurrence and related influencing factors of medical errors
Technology, Wuhan, China among emergency nurses in China are very insufficient.
3
Department of Nuclear medicine, Design: A nationwide cross-sectional study.
Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Methods: A nationwide cross-sectional study was conducted from July 2018–August
Technology, Wuhan, China 2018. A total of 17,582 emergency department nurses from 31 provinces across
4
Key Laboratory of Emergency and
China were eventually included in the analysis. Logistic regression is applied to exam-
Trauma of Ministry of Education, Hainan
Medical University, Haikou, China ine the association of the independent variables with the perceived medical errors.
5
Department of Emergency Medicine, The reporting of this study was compliant with the Strengthening the Reporting of
Sichuan Provincial People's Hospital,
University of Electronic Science and Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
Technology of China, Chengdu, China Results: Of 17,582 participating nurses, 4445 (25.28%) reported self-perceived medi-
6
Research Unit of Island Emergency
cal errors in the past 3 months. Nurses who were serving as nurses-in-charge; who re-
Medicine, Chinese Academy of Medical
Sciences (No. 2019RU013), Hainan ported fair or bad physical health; who reported staff shortage; who were exposed to
Medical University, Haikou, China
more verbal abuse at work; who experienced effort–reward imbalance; who reported
Correspondence more over-commitment; or who had depressive symptoms were more likely to report
Xiaoxv Yin, Department of Social
medical errors. Older age and female gender were protective factors.
Medicine and Health Management,
School of Public Health, Tongji Medical Conclusions: In this study, a quarter of the emergency nurses reported that they had
College, Huazhong University of Science
made medical errors in the past 3 months. Self-perceived medical errors are associ-
and Technology, No.13 Hangkong Road,
Wuhan 430030, China. ated with multiple domains of work-related factors and personal distress. Feasible
Email: [email protected]
measures should be taken to reduce nurses’ workload, improve their working envi-
Funding information ronment, monitor and minimise the occurrence of medical errors among emergency
This study was supported by the Major
department nurses.
Science and Technology Projects
(ZDKJ202004) and Key Research and Relevance to clinical practice: Emergency nurses, who are the most frequently in con-
Development Program (ZDYF2020112),
tact with patients, play an important role in identifying risk factors and preventing
Department of science and technology
of Hainan Province. The funding resource medical errors. Identifying risk factors that may lead to medical errors in the medical
had no role in study design; data
environment from both internal and external aspects will help nursing practitioners,
collection, analysis and interpretation
106 | © 2022 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/jocn J Clin Nurs. 2023;32:106–114.
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WANG et al. 107
of data; writing of the report; or in

the decision to submit the article for hospital administrators and policy makers to take timely preventive measures to re-
publication.
duce the occurrence of medical errors and reduce harm to patients.
KEYWORDS
China, emergency nurses, medical errors, personal distress, work-related factors
1 | I NTRO D U C TI O N
What does this paper contribute to the wider
The problem of medical errors is a major source of reducing the qual-
global community?
ity of medical services. They pose a great threat to patient safety in
• Studies about the occurrence and related influencing
healthcare practice. It is estimated that medical errors cause up to
factors of medical errors among emergency nurses
400,000 patient deaths each year worldwide (James, 2013). Medical
in China are very inadequate. This paper showed that
errors not only increase the cost of hospitalisation but also are the
self-perceived medical errors are common among emer-
main reason of resulting in medical disputes. Since 1999, medical er-
gency nurses in China.
rors have received increased attention, and this problem is an impor-
• Multiple domains of work-related factors associated
tant concern for both healthcare professionals and patients (Institute
with the occurrence of medical errors. Nurses with
of Medicine Committee on Quality of Health Care in America, 2000;
the title of nurses-in-charge; who reported shortage
West et al., 2006).
of nurses; who were exposed to more verbal abuse at
The emergency department is a complex and dynamic place with
work; who experienced effort–reward imbalance; who
a high incidence of medical errors. As part of a multidisciplinary
reported more over-commitment were more likely to re-
team, the role of the emergency department nurses in recognis-
port medical errors.
ing and responding to the patients with urgent conditions cannot
• Nurses who had depressive symptoms were more likely
be understated (Harley et al., 2019; Henneman et al., 2010; World
to report medical errors.
Health Organization, 2019). Since clinical nurses rely on physicians’
instructions for much of their work, the omissions in the handoff
and communication with various personnel are closely related to
the occurrence of medical errors (Hakimzada et al., 2008; Starmer (Gu & Itoh, 2012; Li et al., 2020). The incidence of medical errors
et al., 2014; Topcu et al., 2017). A multicentre intervention study re- and their associated factors among Chinese emergency department
ported by the New England Journal of Medicine showed that 24.5% nurses are poorly known and there are no studies examining the
of medical errors were associated with the work handoff of health- relationship between medical errors and personal distress of emer-
care workers (Starmer et al., 2014). A study in Turkey including 1654 gency department nurses. Studies have shown that in addition to
nurses showed that 52.3% of participants who experienced medical the impact on patient safety, medical errors can also have a negative
errors reported that it was due to communication failures (Topcu impact on the emotions of healthcare workers, such as depression
et al., 2017). In addition, emergency departments are characterised and burnout, which in turn can lead to an increased risk of med-
by high patient volume, rapid onset of disease, complex disease ical errors (Hall et al., 2016; Kalisch & Xie, 2014; Shanafelt et al.,
types and rapid changes in conditions (Kovacs & Croskerry, 1999; 2010). It is necessary to explore the occurrence and related factors
Zhou, 2006). In such a department with special working character- of medical errors among emergency department nurses. Therefore,
istics and medical environment, medical decisions are made under a large-scale cross-sectional survey was conducted among Chinese
pressure and with incomplete information (Brixey et al., 2007), re- emergency department nurses, aimed to understand the prevalence
sulting in a higher risk of medical errors than in other medical units of self-perceived medical errors and its associated factors. Thus,
(Subeq et al., 2018). this study could provide an empirical basis for developing nursing
The history of emergency medicine in China is relatively short, management measures to reduce the occurrence of medical errors
and the service system of the emergency medical still needs to among emergency department nurses.
be improved. Coupled with China's large population and insuffi-
cient number of emergency medical staff, Chinese emergency de-
partments have been carrying a heavy workload, which may make 2 | M E TH O D S
Chinese emergency medical staff more prone to medical errors (Shi
et al., 2020). However, studies related to medical errors in China This study followed the STROBE checklist for cross-sectional stud-
have mainly focused on the physicians’ or patients’ perspectives ies (Appendix S1).
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108 WANG et al.
2.1 | Ethical considerations 2.4 | Outcome
This study was approved by the Medical Ethics Committee of Hainan In this study, self-perceived medical errors were investigated using
Medical College (HYLL-2018-035). All participants were voluntary a question, ‘Are you concerned that you have made any major medi-
and all identifiable details of study participants were kept confiden- cal errors in the last 3 months?’ with two response options ‘Yes’
tial. Information about the study purpose and the time needed to and ‘No’. This question has been used in many excellent studies
complete the questionnaire were explained to the participants at the (Shanafelt et al., 2010; West et al., 2006). It is intended to identify
beginning of the survey. recent events internalised by healthcare professionals as significant
medical errors rather than to document real events related to patient
outcome.
2.2 | Study design and data collection
This research was a nationwide cross-sectional study titled ‘Pre- 2.5 | Work-related factors
hospital Emergency Survey’. From July 2018–August 2018, with the
coordination of the Medical Administration Bureau of the National Occupational stress was measured using the Chinese version of the
Health Commission of the People's Republic of China, the link of the Effort–Reward Imbalance (ERI), consisting of 23 items assessing ‘ex-
web-based questionnaires was posted on the emergency nurses' trinsic effort’ (six items), ‘reward’ (11 items), and ‘over-commitment’
working platform of the prehospital emergency facility configura- (six items) (Li et al., 2005). Extrinsic effort refers to the requirements
tion monitoring department. Emergency department nurses were and needs of the job (time, responsibility and physical load). Reward
invited to participate anonymously in this cross-sectional online describes three aspects of the job: esteem, job promotion and job
survey. The link of the questionnaire was reposted to the work- security. Over-commitment measures subjects’ motivational pat-
ing platform every 7 days to remind emergency nurses to engage terns in response to demands and is characterised by a tendency to
in the survey until it ended. All participants were required to read over-immerse oneself in work. Responses to the items of ‘extrinsic
and agree to an electronic version of the informed consent state- effort’ and ‘reward’ were rated on a 5-point Likert scale, ranging from
ment before they could complete the survey by visiting the link. A 1 (‘no stressful experience’) to 5 (‘very high stressful experience’).
total of 25,518 nurses clicked on the questionnaire link during the The items of the scale ‘over-commitment’ are scored on a 4-point
study period. Finally, a total of 17,582 licensed nurses working in the scale (1 = full disagreement, 4 = full agreement with statement).
emergency departments completed the survey, giving a completion The extent of occupational stress can be expressed by the effort–
rate of 68.9%. reward ratio (ERR) and over-commitment, independently. The ERR
was calculated by the following formula: ERR = 11*Effort/6*Reward.
The greater the ERR value, the higher the occupational stress level.
2.3 | Measurements A score above 1.00 reflected an effort–reward imbalance. The
Cronbach's α for extrinsic effort, reward and over-commitment was
A standard structured anonymous questionnaire administered by 0.82, 0.93 and 0.84 respectively.
an online survey platform in China (platform name: Questionnaire
Star, website: https://www.wjx.cn) was used to collect, save and
manage data. If there were incomplete questions, the question- 2.6 | Personal distress
naire cannot be submitted. The questionnaire was developed
based on a review of published literature. A pilot study includ- The Patient Health Questionnaire (PHQ-9) was used to measure de-
ing 30 nurses was conducted before the formal survey to pre- pressive symptoms (Chen et al., 2013; Kroenke et al., 2001). This
test that the questions were clear and easy-to-u nderstand to all instrument screens the subjects for the presence and severity of
participants. depression over the last two weeks. The scale consists of 9 items,
The items of the questionnaire covered socio-demographic each of which was rated on a scale ranging from 0 (‘not at all’) to 3
characteristics, self-perceived physical health, work-related fac- (‘nearly every day’). The total score ranged from 0–27. Higher scores
tors, personal distress and the outcome variable of self-perceived indicated the presence of more depressive symptoms. The cut-off
medical errors. Socio-demographic characteristics, including sex, points of 10 represented major depressive symptoms. Cronbach's α
age and educational levels, were collected. Work-related factors of this scale was 0.90, indicating good reliability.
comprised professional title, frequency of suffering from work- Negative emotion was measured by the subscale of negative af-
place verbal abuse in the past year, perceived shortage of nurses fect (5 items) derived from the 10-item Positive and Negative Affect
and occupational stress. Personal distress included depressive Schedule (PANAS) developed by Watson et al. (1988). Each item of
symptoms, negative affect, satisfaction with work and generalised negative affect was rated based on a 5-point Likert scale, ranging
self-efficacy. from 1 (‘strongly disagree’) to 5 (‘strongly agree’), yielding scores
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WANG et al. 109
between 5–25. Higher scores reflect a higher level of negative emo- nurses had a bachelor's or higher degree. The proportion of nurses
tion. In our research, the negative affect subscales (Cronbach's α reporting good self-perceived physical health was 22.52%. About
equal to 0.86 in this study) demonstrated high internal consistency. half (50.24%) of the nurses reported staff shortage. Concerning ex-
To assess participants’ job satisfaction, we used the Job posure to verbal abuse at work, almost 70% of the nurses encoun-
Satisfaction scale derived from Leiden Quality of Work Questionnaire tered workplace verbal abuse in the past years. The mean score of
(van der Doef & Maes, 1999). This scale consists of 6 items rated the ERI for the nurses was 1.24 (SD = 0.59). There were 59.66% of
on a 4-point Likert scale, ranging from 1 (‘strongly disagree’) to 4 nurses reported an ERI score that indicated the effort–reward im-
(‘strongly agree’). Higher scores indicate higher satisfaction. In this balance. The mean score of the PHQ-9 was 7.53 (SD = 4.98), and
study, the reliability for this scale was strong (Cronbach's α equal to 26.03% of the nurses had major depressive symptoms.
0.85 in this study). Of 17,582 participating nurses, 4445 (25.28%) reported per-
We used the 10-item Generalised Self-efficacy Scale (GSE) to ceived medical errors during the previous 3 months prior to the sur-
evaluate the generalised self-efficacy (Schwarzer et al., 1997). This vey. The results of the association between sample characteristics
scale reflects the self-confidence of individuals in the face of set- and perceived medical errors are presented in Table 1. All demo-
backs or difficulties. The items of GSE were rated on a 4-point Likert graphic characteristics, work-related factors and personal distress
scale from 1 (‘completely incorrect’) to 4 (‘completely correct’), yield- were associated significantly with perceived medical errors. Post
ing scores between 10–4 0, with higher scores indicating a higher hoc comparison showed that there was a statistically significant
level of the generalised self-efficacy. The reliability of the scale was difference in the risk of medical errors between different groups
strong (The Cronbach's α equal to 0.92 in this study). of nurses with different health status (p < .0001), and between
nurse-in-charge and senior nurses (p = .0249). There was no differ-
ence in the risk of medical errors between nurses who experienced
2.7 | Statistical analysis four to six episodes of workplace verbal abuse in the past year and
those who experienced seven or more, and statistical differences
All data analyses were conducted using the Statistical Analysis were found between all other groups (p < .0001). The occurrence
System (SAS) version 9.4 for Windows (SAS Institute Inc., Cary). of self-perceived medical errors increased with the deterioration of
Descriptive analysis included means and standard deviations (SD) self-perceived physical health, and increased with the increase in
for continuous variables and frequencies and percentages for cat- workplace verbal abuse.
egorical variables. Chi-square tests were conducted to compare Table 2 demonstrated the adjusted ORs and 95% CIs for per-
the prevalence of perceived medical errors across groups defined ceived medical errors. The results indicated that age was negatively
by demographic data, self-perceived physical health, work-related associated with a self-reported medical error (OR =0.85, 95% CI:
factors and personnel distress. T-tests were conducted to com- 0.79–0.91). Compared with males, females had lower odds of report-
pare the mean age, the over-commitment score, the negative affect ing errors (OR = 0.77, 95% CI: 0.69–0.87). Nurses who were serv-
score, the job satisfaction score and the generalised self-efficacy ing as nurses-in-charge; who reported fair or bad physical health;
score between groups with or without medical errors. For variables who reported staff shortage; who were exposed to more verbal
with more than two levels, we conducted a post hoc comparison abuse at work; who experienced effort–reward imbalance; who had
to determine between-group differences. To appropriately protect depressive symptoms were more likely to report medical errors.
against type 1 error in the context of a Chi-square test we used the Additionally, each 1-point increase in over-commitment score was
post hoc approach known as the Bonferroni Adjustment. For ordinal associated with a 0.12-unit increase in the odds of a self-reported
categorical variables, we conducted Mantel–Haenszel Chi-square error in the previous 3 months for nurses. Each 1-point increase in
test. Finally, multivariable logistic regression analysis was performed negative affect score was related to a 40% increase in the odds of a
to examine the association of the independent variables with the self-perceived error. Each 1-point increase in self-efficacy score was
perceived medical errors, and adjusted odds ratios (ORs) and 95% associated with a 15% decrease in the odds of a self-perceived error.
confidence intervals (95% CIs) for each variable were presented. In In the stratified analysis of gender (Table S1), the factors influencing
addition, stratified analysis of gender and self-perceived physical the occurrence of medical errors among female nurses were consis-
health was performed. For all comparisons, differences were tested tent with the results of the whole population. The factors associated
using two-t ailed tests and p-values < .05 were considered statisti- with the occurrence of medical errors differed between the male
cally significant. and female groups. The stratified analysis of self-perceived physical
health displayed consistent results with this study (Table S2).
3 | R E S U LT S
4 | DISCUSSION
Table 1 presents participants’ characteristics. A total of 17,582
nurses were investigated in this study. The mean age of the par- This nationwide cross-sectional study showed that self-perceived
ticipating nurses was 29.92 (SD = 6.75). Nearly half (44.78%) of the medical errors were common among emergency department nurses.
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110 WANG et al.
TA B L E 1 Descriptive statistics for characteristic and associations with self-perceived medical errors of the nurse
Nurses who reported errors Nurses who reported no

Nurses (N = 17,582) (N = 4445) errors (N = 13,137)
n % n % n % p
Total 17,582 100.00 4445 25.28 13,137 74.72

Age (mean ± SD) 29.92 ± 6.75 29.61 ± 6.38 30.02 ± 6.87 .0003a
Sex
Male 1803 10.25 530 29.40 1273 70.60 <.0001
Female 15,779 89.75 3915 24.81 11,864 75.19
Education level
Associate degree or 9708 55.22 2296 23.65 7412 76.35 <.0001
vocational diplomab
Bachelor's degree or higher 7874 44.78 2149 27.29 5725 72.71
Self-perceived physical health
Good 3960 22.52 559 14.12 3401 85.88 <.0001
Fair 9325 53.04 2338 25.07 6987 74.93
Bad 4297 24.44 1548 36.03 2749 63.97
Work-related factors
Job title
Nurse practitioner 14,041 79.86 3527 25.12 10,514 74.88 .0249
Nurse-in-charge 3162 17.98 840 26.57 2322 73.43
Senior nurses 379 2.16 78 20.58 301 79.42
Shortage of nurses
No 8748 49.76 1809 20.68 6939 79.32 <.0001
Yes 8834 50.24 2636 29.84 6198 70.16
Workplace verbal abuse (times)
0 5351 30.43 776 14.50 4575 85.50 <.0001
1~3 7369 41.91 1950 26.46 5419 73.54
4~6 1914 10.89 642 33.54 1272 66.46
7~ 2948 16.77 1077 36.53 1871 63.47
Effort–reward imbalance
No 7093 40.34 1205 16.99 5888 83.01 <.0001
Yes 10,489 59.66 3240 30.89 7249 69.11
Over-commitment 17.59 ± 2.65 18.36 ± 2.62 17.33 ± 2.60 <.0001a
(mean ± SD)
Personal distress
Depressive symptoms
No 13,006 73.97 2689 20.68 10,317 79.32 <.0001
Yes 4576 26.03 1756 38.37 2820 61.63
Negative affect 16.26 ± 3.74 17.75 ± 3.62 15.75 ± 3.64 <.0001a
(mean ± SD)
Satisfaction with job 13.22 ± 3.34 12.32 ± 3.23 13.53 ± 3.32 <.0001a
(mean ± SD)
Self-efficacy (mean ± SD) 26.00 ± 6.03 24.70 ± 6.17 26.44 ± 5.92 <.0001a
Abbreviation: SD, standard deviation.

a
This p value is associated with t-tests; all other p-values are associated with chi-squared tests.
b
An associate degree requires 3 years of education in college after graduation from senior middle school (grade year 10 to year 12), or 5 years of
education in college after graduation from junior middle school (grade year 7 to year 9), and a vocational diploma requires 2 years of education in
vocational schools after graduation from senior middle school, or 3 years of education in vocational schools after graduation from junior middle
school.
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WANG et al. 111
TA B L E 2 Multifactor logistic regression analysis for the emergency department nurses had made medication errors in the
associations between predictor variables and self-perceived past year (Ehsani et al., 2013). In this study, the incidence of medical
medical errors errors among emergency department nurses differed significantly
Variables Nurses from those reported in the above studies. This disparity may be due
to the differences in emergency medical service systems in differ-
Agea 0.85 (0.79–0.91)***
ent countries and may also be related to the differences among the
Sex (Ref = male)
respondents. Because of the differences in study populations and
Female 0.77 (0.69–0.87)***
measurement methods, we cannot directly compare the results with
Education level (Ref = Associate degree or vocational diploma) that of the above. Nevertheless, despite the wide variation among
Bachelor degree or higher 1.08 (1.00–1.16) different countries, the incidence of medical errors in emergency
Self-perceived physical health (Ref = good) department nurses was generally severe (Ertem et al., 2009; Kagan
Fair 1.39 (1.25–1.55)*** & Barnoy, 2013; Kiymaz & Koç, 2018).
Bad 1.56 (1.38–1.77)*** This study found that the occurrence of self-perceived med-
Job title (Ref = Nurse practitioner) ical errors among emergency department nurses was associated
Nurse-in-charge 1.18 (1.06–1.32)** with work-related factors such as staff shortages, workplace ver-
Senior nurses 1.18 (0.88–1.59) bal abuse and excessive work stress (effort–reward imbalance and
over-commitment). Over half of the participants in this study re-
Shortage of nurses (Ref = no)
ported shortage of nurses, and 70% of nurses experienced work-
Yes 1.19 (1.11–1.29)***
place verbal abuse in the last year. These findings were consistent
Workplace verbal abuse (times) (Ref = no)
with previous epidemiological studies showing that nurse shortages
1~3 1.61 (1.46–1.77)***
led to high workloads, fatigue and burnout, which were risk fac-
4~6 1.95 (1.71–2.22)***
tors for medical errors in the emergency department (Ehsani et al.,
7~ 1.94 (1.72–2.18)*** 2013). Currently, the lack of trust between healthcare professionals
Effort–reward imbalance (Ref = no) and patients leads to frequent workplace violence including verbal
Yes 1.25 (1.14–1.37)*** threats and even physical assaults, especially in the emergency de-
b
Over-commitment 1.12 (1.07–1.17)*** partment (Gu & Itoh, 2012; Shi et al., 2020). Moreover, many stud-
Depressive symptoms (Ref = no) ies have shown that excessive work stress has a negative impact on
Yes 1.15 (1.05–1.25)** physical and mental health of healthcare workers and the quality of
Negative affect b
1.41 (1.35–1.47)*** care they provide (Vu-Eickmann et al., 2018). The mean scores of
effort–reward imbalance and over-commitment among emergency
Satisfaction with jobb 1.04 (0.99–1.08)
b department nurses in this study (ERI: mean = 1.24, SD = 0.59; over-
Self-efficacy 0.86 (0.83–0.89)***
commitment: mean = 17.59, SD = 2.65) were much higher than those
Note: *p < .05; **p < .01; ***p < .0001 (two-t ailed test).
reported in previous Chinese studies (ERI: mean = 0.66, SD = 0.30
a
The odds ratios of age represent the change in the odds when the
(Li et al., 2005); over-commitment: mean = 16.39, SD = 2.50 (Wu
variable age is increased by 10 years.
b et al., 2014)). Apart from the differences in the enrolled popula-
Parameter estimates indicate the change in each metric associated
with a self-reported medical error. For instance, each 1-point increase in tion, the reasons for these differences may also be related to the
over-commitment score was associated with a 0.12-unit increase in the increasing work pressure of Chinese emergency department nurses.
odds of a self-reported error in the previous 3 months. The results of this study suggested that administrators of medical
institutions should make efforts to rationalise the layout and triage,
In addition to the potential impact on patients, self-perceived medical establish a green channel for emergency treatment and improve the
errors exhibited associations with multiple domains of work-related working environment of the emergency department. At the same
factors as well as personal distress for emergency department time, the number of nursing staff should be increased, and the work-
nurses. This study provided a reference for understanding the load of emergency department nurses should be adjusted to reduce
incidence and influencing factors of medical errors among nurses in the occurrence of medical errors, to ensure the safety of patients’
emergency departments in China, and helped to develop targeted lives as well as the physical and mental health of nurses.
interventions to prevent or reduce the occurrence of medical errors. Previous studies have confirmed that negative emotions of
In this study, a quarter of the participants (25.28%) reported healthcare workers such as burnout and depression can lead to
medical errors in the past 3 months. Prior to this study, studies medical errors and affect the quality of care. It has also been
have been conducted in other countries on the incidence of medical noted that many healthcare workers experience negative emo-
errors in the nurse population, for example, a study conducted in tions as a result of committing medical errors, which in turn af-
2017 in Turkish emergency department nurses showed that 19.4% fects their medical performance. This phenomenon was called the
of participants had made medical errors in the past year (Kiymaz & ‘second victims’ (Pereira-L ima et al., 2019; Shanafelt et al., 2010).
Koç, 2018). Another study carried out in Iran showed that 46.8% of Although this cross-s ectional study could not determine a causal
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112 WANG et al.
relationship between self-p erceived medical errors and personal the emergency department, the findings may not be generalisable
distress, the association between self-p erceived medical errors to other departments.
and negative emotions (depressive symptoms and negative af-
fect) as well as lower self-efficacy among emergency department
nurses was observed. Meanwhile, nurses who reported medical 5 | CO N C LU S I O N S
errors had higher negative affect scores and lower self-efficacy
scores, which to some extent validated the bidirectional associa- Self-perceived medical errors are common in the Chinese emer-
tions mentioned above. At present, only few studies investigated gency department nurses and are associated with work-related
the responses of healthcare workers after committing medical er- factors and personal distress such as staff shortages, workplace
rors themselves, with rate of second victim ranging from 10.4%– verbal abuse, excessive work stress (effort–reward imbalance
43.3% (Lander et al., 2006; Panella et al., 2014; Wolf et al., 2000), and over-commitment), negative emotions and low self-efficacy.
and there are no such studies in China. According to this study, Administrators of medical institutions should take feasible measures
attention to the second victim phenomenon should be paid. to reduce the workload of emergency department nurses, improve
Healthcare facility administrators are expected to develop feasi- the working environment and pay sufficient attention to the physi-
ble preventive interventions. Further relevant interventional re- cal and mental health of healthcare workers. Tools to scientifically
search should be carried out. monitor and document the occurrence of medical errors need to be
Additionally, the results of this study showed that female and developed, and feasible preventive measures to reduce the occur-
older nurses had reported significantly fewer medical errors, which rence of ‘second victims’ need to be explored to minimise the occur-
was consistent with the results of previous studies (Wen et al., rence of medical errors and ensure patient safety.
2016). This may be due to the fact that women are more atten-
tive, and older nurses are more experienced and skilled in nursing.
The stratified analysis showed that some of the influencing factors 6 | R E LE VA N C E TO C LI N I C A L PR AC TI C E
associated with the occurrence of medical errors among female
nurses were not significant in the male nurse. The two main vari- Medical errors are major problems in the medical environment that
ables were workplace verbal abuse and effort–reward imbalance. threatens the life and safety of patients. The emergency medical en-
This may be related to the gender characteristics and personality vironment has characteristics like a large number of patients, com-
traits of men and women. Moreover, the multiple stresses and role plex conditions and rapid progress. Emergency nurses, who are the
conflicts associated with social life may make women more sensi- most frequently in contact with patients, play an important role in
tive to threats and more likely to experience trait anxiety than men identifying risk factors and preventing medical errors. Identifying
(Edward et al., 2016; McClure et al., 2004; Simonds & Whiffen risk factors in the medical environment that may lead to medical er-
et al., 2003; Vanderbroeck & Wasserfallen, 2017), thus affect- rors from both internal and external aspects will help nursing prac-
ing their risk of medical errors. After adjusting for other factors, titioners, hospital administrators and policy makers to take timely
we found that poor self-p erceived physical health increased the preventive measures to reduce the occurrence of medical errors and
risk of medical errors. This finding suggested that administrators provide safe care to their patients.
should pay attention to the nurses with poor self-p erceived health
status. This group of emergency nurses might be more prone to AC K N OW L E D G E M E N T S
experience burnout and other negative emotions, which can di- None.
rectly affect their medical performance and have a detrimental
impact on patient safety (Pereira-L ima et al., 2019; Wallace et al., C O N FL I C T O F I N T E R E S T
2009; West, 2016). None.
There are several limitations in this study. First, this study is a
cross-s ectional study, thus we cannot establish a causal relation- AU T H O R C O N T R I B U T I O N S
ship between self-p erceived medical errors and related influenc- Wang J: conceptualisation, design of the work, analysis, methodol-
ing factors. Further researches need to be conducted to figure out ogy, interpretation of data, software, drafted the work, revision of
the complex interconnections between various factors and med- the work; Mu KT: conceptualisation, design of the work; acquisition,
ical errors. Second, the incidence of medical errors in this study drafted the work; Gong YH: conceptualisation, design of the work,
relied on participants’ self-reports, which may underestimate the analysis, interpretation of data, methodology, software, revision of
actual incidence somewhat. Besides, this study did not use ran- the work, supervision; Wu JX: acquisition, interpretation of data,
dom sampling, which may have biased the responses of the par- drafted the work; Chen ZY: acquisition, analysis, interpretation of
ticipants due to their inclusion method. However, this study was a data, software; Jiang N: interpretation of data, methodology, soft-
large-s cale nationwide survey. The outcomes of this study should ware; Zhang GP conceptualisation, design of the work, revision of
be representative of the general situation of emergency depart- the work; Lv CZ: conceptualisation, investigation, acquisition; Yin
ment nurses in China. Yet, since the survey was only conducted in XX: conceptualisation, design of the work, supervision, revision
|
WANG et al. 113
of the work. All authors have approved the submitted version Kalisch, B. J., & Xie, B. (2014). Errors of omission: Missed nursing care.
Western Journal of Nursing Research, 36(7), 875–890. https://doi.
manuscript.
org/10.1177/0193945914531859
Kiymaz, D., & Koç, Z. (2018). Identification of factors which affect the
DATA AVA I L A B I L I T Y S TAT E M E N T tendency towards and attitudes of emergency unit nurses to make
The datasets analyzed during the current study are available from medical errors. Journal of Clinical Nursing, 27(5–6), 1160–1169.
https://doi.org/10.1111/jocn.14148
the corresponding author on reasonable request.
Kovacs, G., & Croskerry, P. (1999). Clinical decision making: an
emergency medicine perspective. Academic Emergency
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Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9:
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Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

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Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

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Received: 12 September 2021 | Revised: 12 November 2021 | Accepted: 20 December 2021

Occurrence of self-perceived medical errors and its related

of data; writing of the report; or in

2.1 | Ethical considerations 2.4 | Outcome

Nurses who reported errors Nurses who reported no

Total 17,582 100.00 4445 25.28 13,137 74.72

Abbreviation: SD, standard deviation.

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Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

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Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

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Journal of Clinical Nursing - 2022 - Wang - Occurrence of Self‐Perceived Medical Errors and Its Related Influencing Factors

Uploaded by

Copyright:

Available Formats

Received: 12 September 2021 | Revised: 12 November 2021 | Accepted: 20 December 2021

Occurrence of self-­perceived medical errors and its related

of data; writing of the report; or in

2.1 | Ethical considerations 2.4 | Outcome

Nurses who reported errors Nurses who reported no

Total 17,582 100.00 4445 25.28 13,137 74.72

Abbreviation: SD, standard deviation.

You might also like

Occurrence of self-perceived medical errors and its related