Healthcare and Medicine Reference
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case, not only of the professional competencies of the healthcare pro-
viders (knowledge, attitudes, skills), but also of the dispositional states
of all health professionals involved (outlook, mood, inclinations, ethics),
their psychological and physiological condition (stress, fatigue), patient
specifics, dispositional and interactive states (clinical, participation, com-
munication), logistic failures (communication, information, management),
professional setting (physical environment, tools, agents and technolo-
gies used), rules (protocols, guidelines to follow), critical thinking fail-
ures (argumentation, conditionals, rebuttals, lateral thinking, conditions
sine qua non), logistic failures (ensuing decisions made and not made,
their execution and evaluation) good or bad. Alcohol abuse leads to a
set of consequences such as several medical, surgical, neurological, and
psychiatric problems, violent behavior, breakdown of family and profes-
sional relationships, road and work injuries, suicide, and homicide.
In other situations, hereditary predisposition, physical inactivity, dia-
betes, high blood pressure, diet, stress, and other factors are an exam-
ple of a set of causes of heart disease.
Aspirin produces multiple beneficial effects leading to the control of
fever, having an analgesic effect, being a mild anticoagulant preventing
coronary heart disease and perhaps still other unknown effects repre-
senting a set of consequences.
3. Chains of causes or consequences may apply to other cases. Figure 2.9
presents an example of a chain of causes.
Yesterday, a nurse
lost a close family
member.
In deep sorrow, the
nurse did not sleep all
night.
e nurse was called to
do an exceptional shift
at the emergency room.
e nurse worked there
the whole day.
Overworked, the nurse
was late in installing a
medication IV line in a
multiple trauma patient.
e patient's
medication was
delayed (medical
error occurred).
e patient went into
shock (outcome as harm,
result of medical error
at the end of the chain
of preceding causes).
Error
Harm
Figure 2.9
Chain of causes. A hospital setting example.
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