@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2020;26(3):131-137

Background
Ensuring patient safety and preventing medical errors in health care centers is a global issue. ...[1]. Medical errors include requesting inappropriate diagnostic tests, lack of access to the patient's medical history, lack of proper consultation, and incorrect interpretation of tests [2].
Previous Studies
According to the World Health Organization, one in 10 patients is affected by medical errors. ...[3, 4]. Lack of providing midwifery services can cause serious harm to both the mother and the fetus. Identifying the factors related to midwifery errors and providing appropriate solutions to reduce the incidence of errors and their complications has an important role in providing appropriate midwifery services and ensuring public health. Two important midwifery centers, namely health centers and delivery blocks are notable due to their sensitive services and many different patients. It seems that identifying occupational factors leading to midwifery errors in these two work centers, especially identifying workplace deficiencies from the perspective of employed midwives, will lead to widespread identification of occupational factors associated with midwifery errors.
Aim(s)
This study aimed to identify the occupational factors leading to midwifery errors from midwives' perspectives working in the maternity ward and health centers. This study aimed to identify the occupational factors leading to midwifery errors from midwives' perspectives working in the maternity ward and health centers. The aim was to reduce the incidence of errors in the midwifery profession by identifying deficiencies that are not limited to work centers.
Research type
The present study is descriptive.
Research society, place and time
This study was carried out between 252 midwives working in the delivery block and health centers of 3 Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2014.
Sampling method and number
Subjects were selected using Cochran's formula and the available method. The three mentioned universities were considered one class by quota method, and 84 midwives were selected from each university (42 subjects from health centers and 42 subjects from the delivery block). Individuals with at least one year of midwifery experience were included in the study, and incomplete questionnaires were excluded.
Used devices&materials
To conduct the research, a researcher-made questionnaire was used, which was scored based on a 5-point Likert scale from a very high level (5) to ineffective (1). The first part of the questionnaire included demographic information about the participants, and the second part included the occupational factors related to the midwifery profession (23 items). It is noteworthy that the questionnaire questions were extracted based on the study of books and similar articles in the field of medical science errors and occupational factors. To determine the validity, the questionnaire was given to 11 experts and was approved in terms of content and face validity using CVR and CVI. CVI was set at 0.84, and 4 ratings from low to high were designed for each item to check the relevance, simplicity, and clarity of the items. Experts were asked to rate each item in these respects. The average of the rates was calculated for each item. Thus, the mean of relevance, clarity, and simplicity of items were 0.91, 0.97, and 0.97. Cronbach's alpha was 0.94 in respect to internal reliability and consistency. In order to determine the reliability, the test-retest method was used. Thus, ten working midwives who were not between 252 subjects of the study were asked to fill the questionnaire, and two weeks later, the questionnaire was completed by them again. The correlation coefficient between the two rounds was 0.81. Participants were reassured about the confidentiality of the information and the right to non-participation in the study. The questionnaire was provided with sufficient explanations on how to complete the questionnaire and rating. Data were analyzed using SPSS 16 software. The demographic information was investigated by descriptive statistics. Mann-Whitney test was used to compare the views of participants in the two groups on the role of occupational factors in the occurrence of midwifery errors. Also, several types of legal errors were expressed, and the subjects were asked to prioritize legal errors based on their own or one of their colleagues' experiences of error.
Findings by Text
The mean age was 43.30±7.23 for midwives working in the delivery block and 37.30±6.20 for midwives working in health centers. The average work experience of midwives working in the delivery block was 11/10±7.56 and in the health centers was 14.2±6.43. 198 (78.5%) of the participants had a bachelor's degree in midwifery. The highest frequency of the type of university with 202 people (80.2%) was related to the public university. 174 (69.1%) of the participants had formal employment status, and 184 (73%) were married. Except for the five variables of professional liability insurance, hard work of midwifery, patient referral problems, characteristics of officials, and material satisfaction from the job, the other variables had the same role in the occurrence of midwifery errors from the perspective of both groups (p>0.05; Table 1). The first to the fourth priority of midwives errors from the perspective of midwives working in the delivery block included the carelessness, incompetence, lack of skill, and failure to comply with government laws and From the perspective of midwives working in health centers included the carelessness, incompetence, and lack of skill and failure to comply with government laws (Table 2).
Main comparison to the similar studies
The difficulty of midwifery work was one of the factors that had a greater role in midwifery errors from the perspective of midwives working in health centers. Nobahar states that occupational burnout increases the likelihood of occupational errors and their complications. Insufficient scientific information from the perspective of the two participant groups was one of the important causes of midwifery errors and had the same role in midwifery errors. Kawamaro states that nurses' lack of pharmacological knowledge is one of the important causes of their medication errors. Lip's study results show that 15% of nurses' medication errors are due to their lack of medication information. Other researchers cite increasing nurses' medication information as an effective way to reduce their errors [8]. Pay attention to clinical supervision and the lack of staff skills in using medical equipment are important factors in midwifery errors, which had the same role in midwifery errors from both groups' perspectives. Mohammadfam et al., in their study, stated that the harm of health care workers and medical errors is caused or increased by factors such as staff inexperience [9]. The results showed that the nature of midwifery from the two participating groups' perspectives has an important role in midwifery errors. Masoudi et al. stated that nurses' difficulty and the pressure caused by high workload and welfare problems of nurses are among the factors affecting occupational burnout [10]. However, Samadi Miarklaei et al. stated that the workforces that experience less burnout are a more efficient and effective force for their organization [11]. The results showed that carelessness error with a frequency of 43.6%, from the perspective of midwives working in the delivery block, was the most common type of legal error committed by themselves or their colleagues. Bagherian Mahmoudabadi et al. stated that the most common type of legal error in midwives was non-compliance with government laws with a frequency of 44.4% [12]. Incompetence error with a frequency of 48.4% was the most common legal error committed by midwives working in health centers or their colleagues. The study of Tadayon et al., which was conducted to investigate gynecologists and midwives' negligence, showed that most types of negligence were related to Incompetence [13], which is consistent with the views of midwives working in health centers participating in this study.
Suggestions
To reduce midwifery errors and their complications, the following is recommended: Working midwives should pay more attention to their professional responsibilities, including obtaining a patient's clinical history, careful examination of tests, medications, and other professional responsibilities. - Heads of midwifery departments should have more control over the division of midwifery shifts and balancing work of midwifery staff. - Midwives should be employed in midwifery departments, and they should be provided with appropriate employment and promotion opportunities. To strengthen midwives' practical skills, regular retraining sessions and practical exams should be held at their workplace. - Pay special attention to the economic situation as well as the welfare of midwives in the workplace. - Provide professional liability insurance for all employed midwives. - Practical measures should be taken for the insurance contract with the stamp of the midwifery medical system.
Limitations
No limitation was reported by the authors.
Conclusions
Occupational factors are an important cause of midwifery errors. Therefore, planning to strengthen the factors that reduce error and eliminate or reduce the factors that increase the incidence of midwifery errors, such as paying attention to stress-reducing factors and modulating the difficulty of midwifery work in the workplace, is necessary.
Acknowledgments
Occupational factors are an important cause of midwifery errors. Therefore, planning to strengthen the factors that reduce error and eliminate or reduce the factors that increase the incidence of midwifery errors, such as paying attention to stress-reducing factors and modulating the difficulty of midwifery work in the workplace, is necessary.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
The ethical code of this study is SBMU2.REC.1394.86.
Funding Sources
The research is funded by Shahid Beheshti University of Medical Sciences and Health Services.

TABLES and CHARTS

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