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J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec;35(6):746-54.

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

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  • 1Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.



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.


Qualitative descriptive method.


Randomly selected 4 large neonatal intensive care units in Thailand.


Twenty-seven neonatal intensive care unit nurses.


A semistructured interview of the nurses' experience of neonatal intensive care unit error, factors forming barriers to safe practice, and neonatal outcome.


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.


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.

[PubMed - indexed for MEDLINE]
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