The nurses' experience of barriers to safe practice in the neonatal intensive care unit in Thailand

J Obstet Gynecol Neonatal Nurs. Nov-Dec 2006;35(6):746-54. doi: 10.1111/j.1552-6909.2006.00100.x.


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.

Design: Qualitative descriptive method.

Setting: Randomly selected 4 large neonatal intensive care units in Thailand.

Participants: Twenty-seven neonatal intensive care unit nurses.

Main outcome measures: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Clinical Competence
  • Communication
  • Decision Making
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intensive Care Units, Neonatal / organization & administration*
  • Interprofessional Relations
  • Medical Errors / nursing
  • Medical Errors / prevention & control*
  • Medical Errors / statistics & numerical data
  • Neonatal Nursing / education
  • Neonatal Nursing / organization & administration
  • Nurse's Role / psychology
  • Nursing Methodology Research
  • Nursing Staff, Hospital / education
  • Nursing Staff, Hospital / organization & administration
  • Nursing Staff, Hospital / psychology*
  • Outcome Assessment, Health Care
  • Personnel Staffing and Scheduling / organization & administration
  • Qualitative Research
  • Safety Management / organization & administration*
  • Self Efficacy
  • Surveys and Questionnaires
  • Systems Analysis
  • Thailand
  • Workload