Factors Contributing to Nursing Errors Among Nurses Working in Critical Care Units: A Study of Teaching Hospitals in Yazd City

Document Type : Original Article

Authors

1 Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 Health Policy and Management Research Center, Department of Health Management & Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd

10.34172/jhad.1249

Abstract

Introduction: Nursing errors in critical care settings threaten patient safety and the quality of healthcare delivery. Understanding nurses’ perceptions of the factors contributing to these errors is essential for designing effective preventive strategies. This study aimed to assess the perceived factors contributing to nursing errors and their association with demographic and occupational characteristics among nurses working in intensive care units (ICUs) and coronary care units (CCUs).
Methods: This cross-sectional study was conducted in 2025 among 201 nurses working in the ICUs and CCUs of two teaching hospitals in Yazd, Iran. All eligible nurses were recruited using a census sampling method. Data were collected using a previously validated questionnaire evaluating four dimensions of perceived factors contributing to nursing errors: ward management, nurses’ skills and training, environmental conditions, and team coordination. Data were analyzed using descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, and a multivariable general linear model.
Results: The mean total score of perceived factors contributing to nursing errors was 69.53 ± 17.24. Overall, 52.2% of nurses rated these factors as moderate, 35.3% as poor, and 12.4% as desirable. Ward management had the highest mean score (22.08 ± 6.03), whereas team coordination had the lowest (12.41 ± 3.64). Male nurses reported significantly higher scores than female nurses in the domains of ward management (P = 0.029), skills and training (P = 0.042), and environmental conditions (P = 0.031). Nurses working in CCUs reported significantly higher scores across all questionnaire dimensions than those working in ICUs (P < 0.05). In the multivariable analysis, gender (P = 0.021) and type of critical care unit (P = 0.024) remained independently associated with the total score.
Conclusion: Nurses perceived the factors contributing to nursing errors to be at a moderate level. Perceptions differed according to gender and type of critical care unit. These findings highlight the importance of strengthening ward management, enhancing continuing professional education, improving the work environment, and promoting effective team coordination to reduce the perceived contributors to nursing errors and improve patient safety in critical care settings.

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References

  1. Vincent C, Amalberti R. Safer Healthcare: Strategies for the Real World. Cham: Springer; 2016.
  2. World Health Organization (WHO). Patient Safety: Global Action on Patient Safety. WHO; 2019.
  3. Stenberg K, Hanssen O, Edejer TT, Bertram M, Brindley C, Meshreky A, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Health 2017;5(9): e875-87. doi:10.1016/s2214-109x(17)30263-2
  4. World Health Organization (WHO). Meeting Report: WHO Technical Consultation: Nutrition-Related Health Products and the World Health Organization Model List of Essential Medicines: Practical Considerations and Feasibility: Geneva, Switzerland, 20-21 September 2018. Geneva: WHO; 2019.
  5. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016;353: i2139. doi:10.1136/bmj.i2139
  6. Griffiths P, Maruotti A, Recio Saucedo A, Redfern OC, Ball JE, Briggs J, et al. Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf 2019;28(8):609-17. doi:10.1136/bmjqs-2018-008043
  7. Oliveira RM, de Arruda Leitão IM, da Silva LM, Figueiredo SV, Sampaio RL, Gondim MM. Strategies for promoting patient safety: from the identification of the risks to the evidence-based practices. Esc Anna Nery 2014;18(1):122-9. doi:10.5935/1414- 8145.20140018
  8. Slawomirski L, Auraaen A, Klazinga N. The Economics of Patient Safety. Paris: Organisation for Economic Co-operation and Development; 2017.
  9. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. An official critical care societies collaborative statement: burnout syndrome in critical care health care professionals: a call for action. Am J Crit Care 2016;25(4):368-76. doi:10.4037/ ajcc2016133
  10. Blackstone SW, Pressman H. Patient communication in health care settings: new opportunities for augmentative and alternative communication. Augment Altern Commun 2016;32(1):69-79. doi:10.3109/07434618.2015.1125947
  11. Aiken LH, Cerón C, Simonetti M, Lake ET, Galiano A, Garbarini A, et al. Hospital nurse staffing and patient outcomes. Rev Med Clin Las Condes 2018;29(3):322-7. doi:10.1016/j. rmclc.2018.04.011
  12. Carayon P, Gurses AP. Nursing workload and patient safety—a human factors engineering perspective. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008.
  13. Vehvilainen E, Charles A, Sainsbury J, Stacey G, Field-Richards SE, Westwood G. Influences of leadership, organizational culture, and hierarchy on raising concerns about patient deterioration: a qualitative study. J Patient Saf 2024;20(5): e73- 7. doi:10.1097/pts.0000000000001234
  14. Anoosheh M, Ahmadi F, Faghihzadeh S, Vaismoradi M. Survey of predisposing causes of working errors in nursing cares from perspective of nurses and their mangers perspectives. Iran Journal of Nursing 2007;20(51):25-36.
  15. Mashouf S, Esmaeilpour-Zanjani S, Sheikhi AA. The study of factors predisposing nursing errors in intensive care units from selected hospitals’ nurses’ perspectives in Tabriz. J Health Care 2013;15(1):16-25. [Persian].
  16. Faramarzpour M, Najafi K, Ardeshiri R, Zafar Nia N, Askari Zadeh Mahani M. The causes of common errors in nurses. J Jiroft Univ Med Sci 2018;4(2):173-82. [Persian].
  17. Bagaei R, Nadari Y, Khalkhali HR. Evaluation of predisposing factors of nursing errors in critical care units of Urmia medical science university hospitals. Nurs Midwifery J 2012;10(3):312- 20. [Persian].
  18. Tabarsi B, Javadzadeh S, Moeini F. Investigating the frequency and causes of nursing errors from the perspectives of emergency department nurses. Iran J Nurs Res 2022;17(5):38-45. doi:10.22034/ijnr.17.5.38
  19. Ansari M, Sharifi S, Peikari HR, Etebarian Khorasgani A. Investigation of different types of nursing errors based on their lived and working experiences in health centers; a qualitative study. Quarterly Journal of Nursing Management 2020;9(4):11- 9. [Persian].
  20. Dall’Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: a systematic review of longitudinal studies. Int J Nurs Stud 2022;134:104311. doi:10.1016/j.ijnurstu.2022.104311
  21. Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: a systematic review. Nurs Health Sci 2023;25(4):497-515. doi:10.1111/nhs.13052
  22. Reason J. Human Error. Cambridge University Press; 1990.
  23. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 2014;383(9931):1824-30. doi:10.1016/s0140-6736(13)62631-8
  24. Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf 2014;23(5):359-72. doi:10.1136/bmjqs-2013-001848
Health and Development Journal
Volume 15
Pages 1-8

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History

  • Receive Date: 12 January 2026
  • Revise Date: 04 July 2026
  • Accept Date: 29 July 2026

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