Purpose: The purpose of this study was to describe nurses' experiences of patient safety incidents. Methods: Data were collected from June 1 to August 31, 2019 through in-depth interviews with 10 nurses who worked in tertiary hospitals. Data were analyzed using Braun & Clarke’s thematic analysis method. Results: Four themes and eighteen sub-themes emerged as follows. ‘Falls resulted in fatal consequences, the importance of precaution education’, ‘Errors occurred due to incompliance to verification protocol’, ‘Responsibility for catching other people's errors’, ‘Hospital environment from the viewpoint of patient safety’. Conclusion: The findings provided valuable information on the nurses’ experiences of patient safety incidents, which may have serious consequences and are not easily addressed. Programs to prevent patient safety incidents and systems to guard against these incidents should be established. Organizational safety culture also needs to be improved.

서 론
    1. 연구의 필요성
    2. 연구목적
연 구 방 법
    1. 연구설계
    2. 연구참여자
    3. 윤리적 고려
    4. 자료수집
    5 자료분석
    6 연구의 엄밀성 확보
연 구 결 과
    주제 1. 치명적 결과를 부르는 낙상, 예방교육의 중요성
    주제 2. 확인절차를 지키지 않아서 발생하는 오류
    주제 3. 타인의 오류를 걸러내야 하는 책임
    주제 4. 환자안전 관점에서 바라본 병원환경
논 의
결 론 및 제 언
REFERENCES

• 김영미(남서울대학교 간호학과) | Kim Young Mee (Department of Nursing, Namseoul University, Cheonan, Korea)