The nurses' experience of barriers to safe practice in the neonatal intensive care unit in Thailand.
OBJECTIVE
To describe barriers nurses experienced in providing safe practice in the neonatal intensive care unit and to investigate area of errors commonly affected when nurses confronted the barriers.


METHODS
Qualitative descriptive method.


METHODS
Randomly selected 4 large neonatal intensive care units in Thailand.


METHODS
Twenty-seven neonatal intensive care unit nurses.


METHODS
A semistructured interview of the nurses' experience of neonatal intensive care unit error, factors forming barriers to safe practice, and neonatal outcome.


RESULTS
Of 245 error events, neonates were identified to suffer 126 (55.5%) adverse events. Five themes emerged as common factors obstructing nurses from incorporating safety processes into their caring roles: human susceptibility to error, system operating care weakness, problematic medical devices, poor team communication, and situational provocation. Multiple barriers were largely associated with understaffing, a sudden increase in patient acuity, multiple assignments, and an inadequate knowledge of safety in neonatal critical care, which often interacted and influenced their performance when processed to a single error occurrence.


CONCLUSIONS
A focus on management of the potential barriers in a system-related human error approach could prevent and intercept future errors in this vulnerable population.
Jirapaet
Veena
V
Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand. jveena@chula.ac.th
Jirapaet
Kriangsak
K
Sopajaree
Chompunut
C
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D007400:Interprofessional Relations; D019300:Medical Errors / Q000451:nursing / Q000517:prevention & control* / Q000706:statistics & numerical data; D017283:Neonatal Nursing / Q000193:education / Q000458:organization & administration; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D036301:Qualitative Research; D017751:Safety Management / Q000458:organization & administration*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D013785:Thailand; D016526:Workload