Henning Cramer

Factors causing or influencing nursing errors as perceived by nurses: findings of a cross-sectional study in German nursing homes and hospitals

AimNurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses.Subject and methodsThe cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods.ResultsHigh workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose “workload” and “interruptions” while nursing home nurses more often ranked “lack of knowledge” and “lack of motivation” as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses’ perception.ConclusionThe findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management.

Public health: a multi-faceted issue

Prize question: What do strategies to provide fluoride-freewater in Ethiopia, the weather in Hong Kong, and scientificpublications on patient safety indicators have in common?“Not much”, you might say, and from a general point ofview, you would probably be right. In the context of PublicHealth, however, there is a common ground.Generally accepted definitions of Public Health claimthat it aims at preventing disease, prolonging life and pro-moting the health of (sub-groups of) the members of society(Winslow 1920; World Health Organization 1952; Commit-tee of Inquiry into the Future Development of the PublicHealth Function 1988). These aims implicate several spe-cific characteristics, e.g.:1. That Public Health is a worldwide issue (Centers forDisease Control and Prevention 2011)2. That Public Health researchers use a broad range ofmethods (Quine and Taylor 1998)3. That Public Health, in fact, is not a genuine discipline inand of itself, but rather that different disciplines engagein Public Health (see Hurrelmann et al. 2012, but alsosee Winslow 1920!)Public Health thus follows an international, multi-disciplinary und multi-method approach. Most issues ofthe Journal of Public Health reflect this, and so does theone at hand with its reports on studies from Africa, Asia andEurope (one of which was furthermore conducted by Amer-ican researchers). Authors come from fields as different asaquatic science, epidemiology, medicine, meteorology,(micro)biology, nursing, psychology etc. Methods reachingfrom natural scientific analyses to psychological tests and“classical” methods of the social sciences (different forms ofquantitative and qualitative surveys and interviews of in-dividuals and of groups) all the way up to the analysis ofscientific literature have been applied.Despite these differences, in some way or other, all thearticles in this issue of the Journal of Public Health add tothe knowledge needed to prevent disease, prolong life andpromote health:– Mahesh et al. evaluated smear test vs. culture testdiagnosis of pulmonary tuberculosis (TB), using spu-tum samples from the patients of an Indian hospital-based TB centre.– Omokhodion andAdebayoassessed occupational haz-ards and health-related problems of Nigerian butchers,applying a questionnaire-based survey and physicalexamination.– Li et al. examined season- and temperature-related ef-fects on the relationship between air pollution and mor-tality in a Chinese metropolis.– Cramer et al. surveyed German nurses on their percep-tion concerning causes of the occurrence of health careerrors.– Asgary et al. used focus groups to explore the percep-tion of stigma and discrimination towards HIV andAIDS patients in Ethiopia.– Zoidaki et al. studied the magnitude of musculoskeletaldisorders among Greek dentists by means of a self-administered questionnaire.– Fong and Ma evaluated the relationship of meteoro-logical factors and admissions to a Hong Kong hospitalfor respiratory and cardiovascular reasons.– Huber and Mosler used structured face-to-face inter-views to examine factors that explain preferencesconcerning two fluoride-free water options in Ethiopia.– Kamal et al. applied a well-recognized health survey toassess the quality of life among Egypt hemodialysispatients.