Abstract
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.