Abstract: Assesses the impact of environmental changes on patient reportable events (falls and aggression) in older persons' wards, using the Kings Fund Healing the Healthy Environment tool to make small changes to a ward environment in order to create a more 'dementia-friendly' setting. Conducts a comparative analysis of incidents in the wards. Obtains staff perspectives on the changes, which included large-face clocks, identifiction of bed spaces, lavender oil diffusion, and viewing gardens.

Abstract: Explores how patient safety is described from the perspective of clinicians and organisational managers in a NZ acute-care hospital, using embedded case study design. Conducts three interviews with health-care managers and 6 focus groups, comprising 19 doctors and 19 nurses. Develops the theoretical concept of safety capability: the ability to provide safe patient care based on resilient culture, anticipation and vigilance, along a continuum of safety levels.

Abstract: The focus of this study is the management of unsafe nursing students within the tertiary education context. The moral dilemmas experienced by nurse educators, specifically linked to the issue of accountability for public safety, are explored. The theoretical framework for the thesis is informed by the two moral voices of justice and care identified by Gilligan and further developed using the work of Hekman and Lyotard. Case study methodology was used and data were collected from three schools of nursing and their respective educational organisations. Interviews were conducted with nurse educators and education administrators who had managed unsafe nursing students. Interviews were also conducted with representatives from the Nursing Council of New Zealand and the New Zealand Nurses Organisation to gain professional perspectives regarding public safety, nurse education and unsafe students. Transcripts were analysed using the strategies of categorical aggregation and direct interpretation. Issues identified in each of the three case studies were examined using philosophical and theoretical analyses. This thesis explores how students come to be identified as unsafe and the challenges this posed within three educational contexts. The justice and care moral voices of nurse educators and administrators and the ways in which these produced different ways of caring are made visible. Different competing and conflicting discourses of nursing and education are revealed, including the discourse of safety – one of the language games of nursing. The way in which participants positioned themselves and positioned others within these discourses are identified. Overall, education administrators considered accountability for public safety to be a specific professional, nursing responsibility and not a concern of education per se. This thesis provides an account of how nurse educators attempted to make the educational world safe for patients, students, and themselves. Participants experienced different tensions and moral dilemmas in the management of unsafe students, depending upon the moral language games they employed and the dominant discourse of the educational organisation. Nurse educators were expected to use the discourses of education to make their case and manage unsafe students. However, the discourses of nursing and education were found to be incommensurable and so the moral dilemmas experienced by nurse educators were detected as differends. This study bears witness to these differends.

Abstract: Examines the impact of advanced assessment skills on patients in medical and surgical wards through nurses' stories of using these skills. Highlights the use of auscultation, palpation and percussion by nurses for complex patient presentations within a wide range of clinical situations. Conducts 12 interviews with five nurses from paediatric and adult medical and surgical wards in a large urban hospital in NZ.

Abstract: Undertakes to explain the experiences of new graduate registered nurses (NGRN) undertaking a nurse entry-to-practice programme (NETP). Uses focus group data to construct a theory of NGRN experience, utilising constructivist grounded theory method. Interviews NGRNs in the Waikato DHB NETP, which uses a bicultural model. Concludes that NGRNs value culture in assessing patient need. Identifies barriers to valuing patients' culture from short staffing, stress and fear, work pressuress, and lack of insight into the cultural needs of patients from team members.

Abstract: The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals.

Abstract: Assesses the safety of actively avoiding endotracheal suction in post-operative cardiac surgical patients ventilated for less than 12 hours. Describes local endotracheal suction practice, and elucidates patient experience of the endotracheal tube and endotracheal suction. Conducts an observational audit describing endotracheal sucion practice within the cardiothoracic and vascular intensive care unit in Auckland City Hospital. Undertakes a prospective, non-inferiority, randomised controlled trial investigating the safety of avoiding endotracheal suction.

Abstract: To find an effective approach to managing or reducing waiting times for lower triage category patients processed through one particular metropolitan emergency department, an extensive search of the literature revealed several different patient flow processes. These approaches are discussed, in relation to suitability for the particular emergency department. The history of triage, including how and why it evolved, plus the realities of triage today are explored. Included are case examples of two patients on a journey through the department the way it is presently, and how it could be if particular approaches are introduced. Extending nursing practice by introducing nurse-initiated x-rays at triage and the introduction of a separate stream for minor category patients in a dedicated ambulatory care area is one approach that could improve waiting times for these patients. There would be the added advantage of improving triage compliance figures for category three patients. The additional costs involved in such a process could be offset by improved efficiency in terms of waiting times, improved triage compliance figures, happier patients and clinical staff, and an emptier waiting room.