国际护理科学（英文）2021，Vol.8Issue(4)：444-452,后插6,10.
护士的二级解决问题行为:从接近失误中学习
Second-order problem solving:Nurses'perspectives on learning from near misses
摘要
Abstract
Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses'perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three ter-tiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan's 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses'role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.How-ever,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.关键词
接近失误/护士/护士作用/患者安全/解决问题/三级医疗中心/4I组织学习模型Key words
Near misses/Nurses/Nurse's role/Patient safety/Problem solving/Tertiary care centers/4I framework of organizational learning引用本文复制引用
杨依,刘华平,Gwen Sherwood..护士的二级解决问题行为:从接近失误中学习[J].国际护理科学（英文）,2021,8(4):444-452,后插6,10.基金项目
This work was supported by National Health Commission of the People's Republic of China,China[Number:201502017]and the Peking Union Medical College,School of Nursing,China[Grant Number 2015002017]. （）
