Nurses' medication errors: an interpretive study of experiences

The meaning that nurses assign to their experiences with medication errors is at the centre of this study. Using discourse analysis within a framework of an interpretive research design, the phenomenon of a not all too uncommon occurrence in nursing practice is examined. The decisions made in such situations have moral implications on a personal, an institutional, and a professional level. Insight into nurses' involvement with medication errors was gained from various data sources. Twelve senior nurses were interviewed and asked about their experiences. In two group discussions, one in Germany, the other in Scotland, ward sisters shared their knowledge and their feelings. Six senior nurses provided written self reports. The participants were asked to talk and write about what helped and what hindered in the situations they had lived through. These interviews, group discussions and self reports provided data on retrospectively recounted experiences. Furthermore, six documents of disciplinary proceedings where the Professional Conduct Committee of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting has dealt with incidents of medication errors supplemented the data. The literature on medication errors provided a fertile backdrop to the study as did the literature on ethics in nursing and on the teaching of ethics in basic and post-basic nurse education. Three key issues are discussed in this study as they evolved from the analysis of the data: The first issue deals with identification and change. Identification, in its various forms, with the image of nursing, with the nursing hierarchy and with the social reality of the health care services, either result in the perpetuation of prevailing practices, or lead to changes in and development of the same. Guilt and reconciliation with human precariousness is addressed as the second issue. Personal failure and the limits of an imperfect world can be come to terms with by regaining professional confidence and by seeing the value basically inherent in nurses' work. The third issue is taken from the areas of teaching and learning. The moral courage that is needed to learn from mistakes can be enhanced through honest dealings with the situation. Where the attention is shifted from the person involved onto the problem at hand, fair judgement may be advanced and the fear of owning up to a mistake be diminished. Not only do the deontological arguments of an ethic of justice have to be pursued, but in addition a teleological line of argument is asking for attention that takes into account the need of carers, to be cared for. Only when reflected upon, can personal experience merge into the stream of development and progress. This study makes a contribution to such reflection