Iran Journal of Nursing

Introduction
Humans can make mistakes. These mistakes are a part of life. Most of mistakes in nursing are preventable. Patient safety is crucial during patient care such that more than 50% of the measures are related to patient safety, nursing errors, and error reporting. Although self-reporting or whistleblowing of errors are not important to many organizations, it is crucial in nursing proffesion because it is sometime associated with patient death. Nursing error reporting is one of the indicators of patient safety and is important for error prevention. Nursing managers have an important role in reducing the incidence of nursing errors. Nursing managers should use management strategies to create a safe climate in the workplace so that nurses can report their errors without having fear of the consequences. This study aims to determine of the factors affecting nursing errors reporting in selected hospitals affiliated to Tehran University of Medical Sciences.
Materials & Methods 
This is a descriptive study. The study population includes all nurses working in intensive care units and general departments of selected hospitals affiliated to Tehran University of Medical Sciences in 2020. Inclusion criteria were: Being involved in direct, continuous and long-term patient care, and no any specific mental illness. Nurses working in managerial and executive positions such as matrons, supervisors, head nurses, and safety experts were excluded because they were not involved in direct patient care.
After obtaining permission from the ethics committee of Tehran University of Medical Sciences and informed consent from the participants, sampling was performed. The number of samples was determined 336 using the Cochran formula and proportional to the size of the study population. The eligible samples were selected by stratified random sampling method. Due to the fact that sampling was performed during the COVID-19 outbreak, considering a 30% sample drop, 450 questionnaires were distributed and 349 questionnaires were returned (77% response rate). Of these, 9 were incomplete; hence, the data of 340 questionnaires were used in the analysis.
The tool used in the present study was a reserache-made questionnaire measuring the components of nursing error reporting. Content validity of the questionnaire was confirmed based on the opinions of 10 experts in nursing care and nursing management. Internal consistency of the questionnaire was determined using Cronbach’s alpha coefficient after distributing questionnaires among 40 participants. Cronbach’s alpha coefficient was then obtained 0.78. Kolmogorov-Smirnov test was used to check the normality of data distribution. Due to the non-normality of the distribution, nonparametric tests (Cramer’s v test and Mann-Whitney U test) were used. Data were described using descriptive statistics. Data were analyzed in SPSS software, version 16.
Results
The mean percentage of nursing errors was 80.29%, and 32.64% of nurses reported errors after observing them. The error reporting rates in the intensive care unit and general department were 48.40 and 23.63%, respectively. Moreover, 52.72% of nurses had no incentive to re-report nursing errors; 49.09% reported the lack of confidentiality in reporting errors; 34.70% reported the errors of coworkers after observing them (whistle-blowers), and 20.58% prevented others from whistleblowing.
The main causes of nursing errors were managerial factors (52.05%), patient and environmental conditions (37.05%), personal and mental conditions (6.47%), and failure to properly follow the care process (4.41%). In terms of the type, the reported errors were related to recording and reporting (41.02%), medication administration errors (33.33%), failure to provide prophylactic care (17.21%), and caring procedures (8.42%). In terms of severity, the reported errors caused almost harm (40.90%), no harm (40.90%), and harm (10.90%).
 Despite the nurses’ positive attitudes towards nursing error reporting,”fear of reprimand” and “managerial barriers” were the most prevalent reasons for not reporting the errors. There were significant relationships between nursing error reporting and hospital ward type, experience of error, errors reporting method, and work experience (P˂0.001). There was a significant relationship between nurses’ attitudes towards self-reporting and whistleblowing of nursing errors (P˂0.001). Nursing error reporting had no significant relationship with gender, type of employment, shiftwork, and marital status (P˃0.05).
Discussion
Reporting of nursing errors by the nurses in this study was very low, despite the high frequency of errors and the positive attitude of nurses towards error reporting. It seems that developing a strategic plan for recording nursing errors and creating an anonymous, effective and efficient error reporting system is necessary for nursing managers. It is recommended that nursing managers identify the factors affecting the occurrence of errors and, by having proper reaction and supportive behaviors against the reported errors, encourage nurses to report the errors without having a fear of reprimand or punishment. Moreover, to increase the nurses’ compliance with the instructions, they should be more involved in the development of programs and, by having a strategic view and a root analysis of errors, turn the threats and errors into an opportunity to learn and prevent the recurrence of errors in the future. In this way, it becomes possible to overcome the barriers to reporting nursing errors in the ward and hospital.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval was obtained from the Ethics Committee of the School of Nursing and Midwifery, Tehran University of Medical Sciences (Code: IR.TUMS. FNM.REC2020.125).

Funding
This article is a part of Amir Ghobadi's master's thesis, nursing management field, which was done with the financial support of the Research Vice-Chancellor of the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences.

Authors' contributions
Conceptualization and design: Hormat Sadat Emamzadeh Ghasemi and Fateme Hajibabaee; data analysis and interpretation: Arezoo Hajrajabi; initial draft preparation: Fateme Hajibabaee and Amir Ghobadi; data collection: Amir Ghobadi; editing & review: Hormat Sadat Emamzadeh Ghasemi and Amir Ghobadi; Data collection: Amir Ghobadi and Parastoo Aryamlo.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the staff of selected hospitals (Imam Khomeini, Shariati, Sina), and the nurses participated in the study for their cooperation. 

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