CHAPTER ONE

INTRODUCTION

This chapter provides an overview of the study by presenting the background of the research, statement of the problem, objectives of the study, research questions, research hypothesis, significance of the study, scope and delimitation of the study, and operational definition of relevant terms. These sections establish the foundation for investigating the factors that hinder nurses from reporting medical errors in Aboh Mbasie General Hospital.

1.1 Background of the Study

Errors in healthcare delivery are recognized as an unavoidable possibility in clinical practice, irrespective of the professional experience, knowledge or competence of healthcare practitioners. Nurses and other healthcare professionals may occasionally make mistakes while carrying out their professional responsibilities, and such errors can occur at different stages of patient care, with consequences ranging from minor complications to severe health outcomes (Crigger, 2014). Nursing errors may arise during routine clinical procedures, medication administration and other nursing interventions. The likelihood of errors may be particularly high in intensive care units because of the complexity of patient conditions and the demanding nature of treatment. Patients in these units often require more frequent medications and clinical interventions than those admitted to other hospital departments, thereby increasing their exposure to potential medical errors (Camiré, Moyen, & Stelfox, 2009). As professionals who provide direct and continuous patient care, nurses have an important responsibility in promoting patient safety and minimizing preventable harm (Chipps, Wills, & Tanda, 2011).

Compared with other members of the healthcare team, nurses generally spend more time attending to patients and are actively involved in their daily treatment and monitoring. This continuous interaction creates several opportunities for clinical errors, particularly when nurses are working under demanding conditions or managing multiple responsibilities (Thomas, 2010). Research has indicated that patients admitted to intensive care units experience an average of 1.7 errors daily, with nearly all patients exposed to at least one potentially life-threatening error during their admission (Moyen, Camiré, & Stelfox, 2014). Similarly, a study conducted by Joolaee, Hajibabaee and Peyrovi (2011) in Iran reported that nurses recalled an average of 19.5 medication errors, while the mean number of reported cases was only 1.3 within a three-month period. This difference highlights the possible gap between the occurrence of medical errors and the willingness of healthcare professionals to report them. According to the professional ethical standards guiding nursing practice, nurses have a responsibility to protect patients from avoidable harm, identify unsafe practices and report professional errors committed by themselves or other members of the healthcare team (Zahedi, Sanjari, & Aala, 2013). Furthermore, healthcare professionals are expected to provide honest and appropriate explanations when errors occur, particularly when such incidents affect patients (Sanjari, Zahedi, & Aalae, 2012). Consequently, medical errors remain a major concern within healthcare systems because of their implications for patient safety, professional accountability and the quality of healthcare delivery (Wiencek & Winkelman, 2010).

Despite the importance of reporting medical errors, many healthcare professionals experience difficulties when disclosing such incidents. Reporting may be associated with fear of punishment, embarrassment, criticism, disciplinary measures and damage to professional reputation. In some healthcare environments, errors are perceived as evidence of incompetence, inadequate knowledge or poor professional commitment, thereby discouraging nurses from reporting incidents (Beccaria & Pereira, 2009). Studies have estimated that between 50% and 96% of adverse events in healthcare settings remain unreported, while approximately half of these incidents may be preventable (Kagan & Barnoy, 2014; Zahedi, Sanjari, & Aala, 2013). An effective reporting system is therefore necessary for identifying the nature, causes and contributing factors of medical errors. Such information enables healthcare institutions to develop appropriate preventive measures and improve the management of existing risks (Waters, 2010). Failure to disclose or properly document medical errors may have serious implications for patients, nurses and healthcare organizations because it limits opportunities for learning, corrective action and prevention of future incidents (Waters, 2010; Rathert & May, 2017).

When medical errors occur, acknowledging the incident and promptly notifying the appropriate hospital authority constitute important professional and ethical responsibilities. Concealing such incidents may expose patients to additional harm and create serious ethical concerns within healthcare practice (Johnstone & Kanitsaki, 2016). Medical error reporting is as important as identifying and correcting errors because it provides valuable information about actual incidents and near misses. Such information helps healthcare institutions understand existing safety problems and establish measures to prevent similar occurrences (Kohn, Corrigan, & Donaldson, 2011). When hospitals systematically examine medication error patterns and identify areas where mistakes frequently occur, they are better positioned to introduce corrective interventions, improve clinical procedures and reduce preventable patient injuries (Association of Operating Room Nurses, 2014). From an ethical perspective, concealing clinically significant errors can undermine the trust established between nurses and patients. It may also damage the reputation of the nursing profession and contradict its established ethical principles and professional obligations concerning patient protection and safety (Johnstone & Kanitsaki, 2016).

The reporting of medication errors also contributes significantly to improving the overall quality of healthcare services. Information obtained through reporting systems helps healthcare institutions identify factors responsible for medication-related incidents and develop appropriate preventive strategies. A study conducted by Koohestani and Baghcheghi (2008) revealed that 75.8% of medication errors committed by the participating nurses (n = 76) were reported to their instructors. This finding demonstrates the importance of examining nurses' attitudes and experiences regarding the reporting of medical errors. Understanding the perceived obstacles that prevent nurses from reporting errors is an essential step towards improving reporting practices and strengthening patient safety measures.

Although previous studies have examined the challenges associated with medical error reporting among nurses in different healthcare settings, there is a need for more institution-specific information concerning the barriers experienced by nurses in Aboh Mbasie General Hospital. Understanding these challenges is necessary for identifying the factors that discourage reporting, examining their underlying causes and developing practical approaches to improve error disclosure and prevention. Therefore, this study focuses on assessing the barriers to reporting medical errors among nurses in Aboh Mbasie General Hospital.

1.2 Statement of the Problem

Medical errors, particularly those associated with medication administration, remain significant challenges to patient safety and effective healthcare delivery. One of the most dangerous situations in clinical practice occurs when a patient receives an incorrect medication, an inappropriate dosage or medication through an incorrect route of administration. Every patient has the right to receive safe and appropriate medical treatment without being exposed to preventable harm resulting from negligence, inadequate professional knowledge or errors in clinical procedures. However, medication-related mistakes continue to occur in healthcare institutions, creating serious concerns for patients, healthcare professionals and hospital management.

The Institute of Medicine's report, To Err Is Human: Building a Safer Health System, brought considerable attention to the magnitude of medical errors and their consequences for patient safety. The report highlighted the substantial number of deaths associated with preventable medical errors in the United States, emphasizing the urgent need for healthcare institutions to strengthen patient safety systems (Institute of Medicine, 2000). Medical errors can result in adverse drug reactions, prolonged hospital admissions, increased treatment expenses, permanent disability and, in severe cases, death. They may also reduce public confidence in healthcare institutions and undermine the effectiveness of healthcare delivery systems (Demehin, Babalola, & Erhun, 2012).

The consequences of medical errors extend beyond the affected patients. Family members, nurses, pharmacists, doctors and other healthcare professionals may also experience emotional and psychological distress when medication-related incidents occur. Healthcare workers involved in such incidents may experience feelings of guilt, anxiety, self-blame and professional disappointment, particularly when the error results in serious patient complications. These experiences may remain with the affected professionals for extended periods (Esi & While, 2011). The Institute of Medicine also identified medical errors as important contributors to patient mortality in the United States, estimating that between 44,000 and 98,000 deaths occurred annually as a result of medical errors in its landmark report (Institute of Medicine, 2000). The wider effects of medical errors include increased healthcare expenditure, prolonged hospitalization, disability, morbidity and mortality.

Furthermore, medication administration errors contribute to a considerable burden on healthcare resources because affected patients may require additional investigations, treatment and extended periods of hospitalization. The financial implications of these incidents place pressure on healthcare institutions and increase the cost of providing medical services. Consequently, preventing medication errors and improving the reporting of such incidents have become important priorities for healthcare administrators and other stakeholders responsible for patient safety (Institute of Medicine, 2000).

Although nurses play a central role in identifying, documenting and reporting medication errors, their experiences and perceptions regarding the factors that discourage reporting require adequate attention. Several nurses may hesitate to disclose medical errors because of fear of disciplinary action, embarrassment, professional criticism, lack of confidentiality, inadequate reporting procedures and unsupportive organizational practices. Such barriers may encourage underreporting, making it difficult for hospital management to identify recurring problems and introduce effective corrective measures.

A proper understanding of the circumstances under which medical errors occur, the reasons healthcare professionals fail to report them and the extent to which reporting systems are utilized is essential for improving patient safety. Without adequate reporting, healthcare institutions may lack the information required to identify unsafe practices, assess risks and implement appropriate preventive interventions.

Despite the important responsibilities of nurses in promoting patient safety, there is a need to investigate the specific barriers affecting medical error reporting among nurses in Aboh Mbasie General Hospital. Therefore, this study seeks to identify the perceived barriers to reporting medical errors, examine the factors responsible for these barriers and determine appropriate strategies for improving error reporting and prevention within the hospital.

1.3 Objectives of the Study

The general objective of this study is to assess the barriers to reporting medical errors among nurses in Aboh Mbasie General Hospital.

The specific objectives are to:

1. Identify the perceived barriers to reporting medical errors among nurses in Aboh Mbasie General Hospital.

2. Examine the factors responsible for the barriers to reporting medical errors among nurses in Aboh Mbasie General Hospital.

3. Identify appropriate strategies for improving the reporting and prevention of medical errors among nurses in Aboh Mbasie General Hospital.

1.4 Research Questions

The following research questions are formulated to guide the study:

1. What are the perceived barriers to reporting medical errors among nurses in Aboh Mbasie General Hospital?

2. What factors contribute to the barriers experienced by nurses in reporting medical errors in Aboh Mbasie General Hospital?

3. What strategies can be adopted to improve the reporting and prevention of medical errors among nurses in Aboh Mbasie General Hospital?

1.5 Research Hypothesis

The study will test the following null hypothesis:

H₀: There is no statistically significant relationship between nurses' years of professional experience and the number of barriers encountered in reporting medical errors in Aboh Mbasie General Hospital.

1.6 Significance of the Study

The findings of this study are expected to be beneficial to nurses, hospital management, patients, healthcare professionals, policymakers and future researchers.

Nurses: The study will provide nurses with a better understanding of the factors that contribute to the underreporting of medical errors. It will also create awareness of the importance of reporting clinical incidents as part of their professional responsibilities. Furthermore, the findings may encourage nurses to recognize reporting as an essential mechanism for improving patient safety rather than merely an administrative requirement.

Hospital Management: The findings will provide relevant information to hospital administrators regarding the challenges that discourage nurses from reporting medical errors. This information may assist management in developing effective reporting procedures, improving communication, promoting accountability and establishing a supportive environment where errors can be reported without unnecessary fear or intimidation. It may also guide the introduction of institutional measures aimed at reducing the occurrence of preventable medical errors.

Patients and Their Families: The study may contribute to improved patient safety by identifying factors that prevent the disclosure and proper management of medical errors. Improved reporting systems can help healthcare institutions recognize unsafe practices, introduce corrective measures and reduce the possibility of repeated incidents. Consequently, patients may benefit from safer and more reliable healthcare services.

Other Healthcare Professionals: The research will provide useful information to doctors, pharmacists, laboratory personnel and other members of the healthcare team regarding the importance of effective medical error reporting. It may encourage collaboration among healthcare professionals in identifying clinical risks, improving communication and developing strategies to prevent avoidable errors.

Healthcare Policymakers and Regulatory Bodies: The findings may provide evidence to support the development and implementation of policies that promote patient safety and encourage transparent reporting of medical errors. They may also contribute to improving institutional standards and strengthening healthcare monitoring systems in Nigeria.

Future Researchers: This study will serve as a reference material for future researchers interested in medical error reporting, patient safety, medication administration errors and nursing practice. It may also provide a foundation for further investigations into the factors influencing underreporting of medical errors in Nigerian healthcare institutions, particularly where local research evidence is limited.

1.7 Scope of the Study and Delimitation

This study is limited to nurses working in Aboh Mbasie General Hospital. It specifically examines the barriers associated with reporting medical errors among nurses within the institution. The major study variables include perceived barriers, factors contributing to underreporting, and strategies for preventing and managing medical errors.

The study will also consider selected sociodemographic characteristics of the respondents, including age, gender, educational qualification and professional experience. In addition, it will investigate the relationship between nurses' years of professional experience and the number of barriers they encounter when reporting medical errors.

The research is restricted to a single general hospital and adopts a cross-sectional approach to data collection. Consequently, the findings will primarily reflect the experiences and perceptions of nurses within the selected institution and may not be directly generalized to all nurses or healthcare facilities in other locations.

1.8 Operational Definition of Terms

For the purpose of this study, the following terms are defined according to their specific application within the research:

Medical Error: This refers to a preventable mistake or failure in the planning or execution of healthcare activities that may result in inappropriate patient care or potential harm. Such errors may occur during diagnosis, treatment, medication administration or other clinical procedures.

Medication Error: This refers to any preventable incident that may lead to inappropriate medication use or patient harm while a medication is being prescribed, dispensed, prepared, administered or monitored by healthcare professionals or patients. The responsibility for preventing such incidents involves all relevant participants in the healthcare delivery process.

Barrier: This refers to any obstacle, condition or circumstance that makes an activity difficult or prevents an individual from carrying it out effectively. In this study, barriers refer specifically to the factors that discourage or prevent nurses from reporting medical errors.

Nurse: A nurse is a qualified healthcare professional who provides nursing care, health education, treatment support and assistance to individuals requiring medical attention. For the purpose of this study, the term refers to nurses employed at Aboh Mbasie General Hospital.

Medical Error Reporting: This refers to the formal process through which nurses communicate, document or notify the appropriate hospital authority about an identified medical error or near-miss incident for investigation, monitoring and preventive action.

Underreporting of Medical Errors: This describes a situation in which medical errors that occur in a healthcare institution are not fully disclosed, documented or communicated through the established reporting system.

Patient Safety: This refers to the prevention of avoidable harm to patients during the provision of healthcare services through appropriate clinical practices, effective communication and systematic risk management.

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