The Journal of the Japan Academy of Nursing Administration and Policies Vol 12, No 1, pp 515, 2008 原著 病棟勤務看護師の勤務状況とエラー ニアミスのリスク要因 Relationship between Risk Factors Related Medical Errors and Working Conditions of Nurses in Acute Care Settings 金子さゆり濃沼信夫伊藤道哉 Sayuri KanekoNobuo KoinumaMichiya Ito Key words : nurses, working conditions, stress, fatigue, medical errors キーワード Abstract This study was carried out to specify risk factors related medical errors and mistakes in working conditions of nurses. Data on the working conditions, job-related stresses, medical errors, and mistakes of 1,339 nurses in 6 teaching hospitals were collected using questionnaire. The logistic regression analysis was used to obtain quantitative relationship between risk factors related medical errors and working conditions. It was found that the stress factors of over working time, break time, job demand, job control, job suitability, job satisfaction, physical stress, mental stress, and fatigue were concerned with medical errors and mistakes. The result implied that the improvement of working conditions of nurses was needed and so that appropriate nurses staffing was discussed for keeping patient safety. 要旨 6 1,339 2007792008411 Department of Health Administration and Policy, Tohoku University Graduate School of Medicine Vol 12, No 1, 2008
Ⅰ. 緒言 2006 200620072003 2004 2004 2007 2003 2005 2005 Suzuki, et al., 2004 2000 Ⅱ. 研究方法 1. 対象および方法 1 6 表 1 1,339 200511 12 2. 調査票の内容 図 1 7 1 7 1 1 2005 57 4 表 1 6 施設の概要 A 400 21.5 21 B 400 15.7 21 C 300 17.0 2.51 D 300 11.7 21 E 400 14.7 21 F 300 18.5 2.51 2005 11 Vol 12, No 1, 2008
図 1 調査内容の枠組み 表 2 6 4 4 2 6 4 4 2 χ 2 tmann-whitney U p0.05 OR 9595 CI SPSS 14.0J for Windows 4. 倫理的配慮 3. 分析方法 Vol 12, No 1, 2008
表 2 仕事のストレス要因, ストレス反応に関する調査項目 Vol 12, No 1, 2008
Ⅲ. 結果 1. 回答者の属性 1,038 77.5 787 131 382 図 2 100 99.6 89.7 33.0 11.03.7 表 3 35.3 31.6 21.0 9.52.4 2. 勤務状況 1 48.4 1 10.2 95.9 43.6 3 6.9 13.9 1 1 1 3 1 1 1.01 1 0.98 0.99 表 4 3. 仕事のストレス要因 9 3 1,339 1,038 77.5 n787 ICU HCC n13116.7 n27434.8 n38248.5 図 2 回収数および分析対象 Vol 12, No 1, 2008
表 3 属性, 勤務状況, ストレス要因およびストレス反応, 不可逆性疲労 n 787 n 131 n 382 p n n n 属性 mean SD 33.09.5 35.6 9.3 31.7 9.3 0.01 a 11.0 9.2 13.8 9.2 9.8 9.1 0.01 a 3.7 3.7 4.4 3.5 3.3 3.7 0.01 c 787 100 131 100 382 100 784 99.6 131 100 381 99.7 0.57 b 3 0.4 0 0.0 1 0.3 706 89.7 113 86.3 352 92.1 0.08 b 81 10.3 18 13.7 30 7.9 278 35.3 41 31.3 150 39.3 0.40 b 249 31.6 40 30.5 119 31.2 19 2.4 5 3.8 10 2.6 75 9.5 15 11.5 33 8.6 165 21.0 30 22.9 70 18.3 6.1 1.0 6.01.0 6.2 1.1 0.04 a 勤務状況 48.411.0 48.6 10.8 48.6 11.5 0.97 a 7.43.2 7.5 3.1 7.4 3.1 0.63 a 1 10.21.0 10.1 0.9 10.2 1.0 0.15 a 95.963.6 84.8 56.9 98.5 60.5 0.03 a 43.613.0 46.3 15.8 43.0 12.9 0.03 a 6.94.8 6.6 4.6 6.8 4.3 0.76 a 13.96.1 13.9 5.9 13.8 6.2 0.91 a 仕事のストレス要因 45 5.7 13 9.9 17 4.5 0.03 b 742 94.3 118 90.1 365 95.5 359 45.6 85 65.4 157 41.1 0.01 b 428 54.4 45 34.6 225 58.9 546 69.5 99 75.6 254 66.7 0.06 b 240 30.5 32 24.4 127 33.3 595 75.6 107 81.7 273 71.5 0.02 b 192 24.4 24 18.3 109 28.5 324 42.2 67 52.3 140 38.3 0.01 b 443 57.8 61 47.7 226 61.7 620 79.4 107 82.3 300 79.2 0.53 b 161 20.6 23 17.7 79 20.8 ストレス反応 595 75.8 119 90.8 258 68.1 0.01 b 190 24.2 12 9.2 121 31.9 684 86.9 120 91.6 321 84.0 0.02 b 104 13.2 10 7.6 61 16.0 不可逆性疲労 528 67.1 104 79.4 233 61.0 0.01 b 260 33.0 27 20.6 149 39.0 300 38.1 63 48.1 126 33.0 0.01 b 488 62.0 68 51.9 256 67.0 a t b χ 2 c Mann-Whitney U p0.05 10 Vol 12, No 1, 2008
表 4 各要因におけるエラー ニアミス発生オッズ比 OR95 CI OR95 CI 勤務状況 0.981.02 0.98 1.02 0.98 0.921.05 0.98 0.90 1.05 1 1.18 0.951.47 1.15 0.91 1.45 1.01 1.01 1.01 1.01 0.98 0.970.99 0.99 0.97 0.99 1.01 0.961.06 1.01 0.97 1.06 0.961.04 0.99 0.95 1.03 仕事のストレス要因 2.37 1.125.01 2.71 1.794.10 1.55 0.982.43 1.78 1.092.92 1.77 1.182.66 1.23 0.732.05 2.42 1.07 5.45 2.75 1.78 4.24 1.51 0.94 2.43 1.73 1.04 2.90 1.72 1.12 2.63 1.31 0.77 2.24 ストレス反応 4.65 2.478.75 2.28 1.134.60 4.21 2.20 8.04 1.98 4.11 不可逆性疲労 2.46 1.543.94 1.88 1.262.82 2.61 1.60 4.24 2.11 1.37 3.23 p 0.05 2.4 2.71.7 1.7 4 4. ストレス反応と不可逆性疲労 Vol 12, No 1, 200811
3 4 4.2 4.7 2.02.3 2.5 2.0 Ⅳ. 考察 20032006 39 24 1 701 44.02 11.3 4 Rogers, et al., 2004 10 Gold, et al., 1992 2.5 2002 2 1991 1999 20022007 12 Vol 12, No 1, 2008
200120032002 1998 4.2 4.7 2005 Suzuki, et al., 2004 2 1 2006 1 Scott, et al., 2006 ; Akerstedt, et al., 2004 ; Suzuki, et al., 20042004 2 4 Vol 12, No 1, 200813
Ⅴ. 結論 謝辞 6 8 引用文献 Akerstedt, T., Knutsson, A., Westerholm, P., et al.2004 Mental fatigue, work and sleep : J. Psychosom. Res., 57, 427433. 2004 5110874883. Gold, D.R., Rogacz, S., Bock, N., et al.1992rotating shift work, sleep, and accidents related to sleepiness in hospital nurses : Am. J. Public Health, 827, 10111014. 2006 2. http://www.mhlw.go.jp/shingi/2006/03/s0327-2c.html20066. 2007 859 68 2001 1616981. 2002 1725057. 2003 41110. 2007 4432938. 2005 25331 40. 1999 12331. 1998 29156158 2006 http://www.irouren.or.jp/jp/html/menu6/pdf/ 20060120-kangojittai-tanjun.pdf2007 5 2007, http://www.irouren.or.jp/jp/html/menu6/pdf/ 070424ishi_jittai_tyosa_shiryo.pdf20074. 20032001. 2006, 219131133 1137. 2000 3983 2531. 2005 423135143. Rogers, A.E., Hwang, W.-T., Scott, L.D., et al.2004the working hours of hospital staff nurses and patient safety : Health Affairs, 234, 202 212. 2002 5755 8. Scott, L.D., Hwang, W.T. & Rogers, A.E.2006The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses : J. Nurs. Adm., 362, 8695. 2004 http://www.ajha.or.jp/about_us/activity/4byou/ object/2004_11.pdf20075. 2005 14 16 Suzuki, K., Ohida, T., Kaneita, Y., et al.2004mental health status, shift work, and occupational accidents among 14 Vol 12, No 1, 2008
hospital nurses in Japan : J. Occup. Health., 46, 448 454. 2004 1991 381103106. Vol 12, No 1, 200815