Stokes, G. (2005). Who cares? Accountability for public safety in nurse education. Ph.D. thesis, , .
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.
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McKelvie, R. (2019). Where we are and how we got here: an institutional ethnography of the Nurse Safe Staffing Project in New Zealand. Doctoral thesis, Massey University, Palmerston North.
Abstract: Charts a detailed description and analysis of how aspects of the strategies of the Nurse Safe Staffing Project work in everyday hospital settings. Argues that nurses' situated knowledge and work are being organised and overridden by competing institutional knowledge and priorities in a competitive institutional environment. Demonstrates the consequences for nurses, patients and staffing strategies. Conducts 30 interviews with 26 participants, including frontline nurses and participants in safe staffing projects.
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Hawes, P. C. (2016). What educational and other experiences assist recently qualified nurses to understand and deal with clinical risk and patient safety? Master's thesis, Victoria University of Wellington, Wellington.
Abstract: Interviews 9 nurses in their first year of clinical practice to investigate how newly-qualified nurses recognise and develop those skills relating to clinical risk and patient safety. Identifies workplace culture, clinical role models, exposure to the clinical environment, experiential learning, narrative sharing, debriefing and simulation as contributing to learning and understanding clinical risk and safe patient care. Considers strategies to facilitate professional development.
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Smythe, E. (2003). Uncovering the meaning of 'being safe' in practice. Contemporary Nurse, 14(2), 196–204.
Abstract: This paper moves away from the prevalent discourse of competence to consider the meaning of the experience of 'being safe' within the context of childbirth. It offers findings from a doctoral study, informed by the philosophies of Heidegger and Gadamer. Following ethical approval, the data was collected in New Zealand by tape-recorded interviews of 5 midwives, 4 obstetricians, 1 general practitioner and 10 women. The method was informed by van Manen. The findings reveal that in seeking the meaning of being safe one needs to be aware that the unsafety may already be present in the situation. Practitioners may be able to do little to rectify the unsafeness. There is, however, a spirit of safe practice, explicated in this paper, that is likely to make practice as safe as it can possibly be. Wise practitioners are ever mindful that a situation may be or become unsafe, and are always aware of their own limitations.
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Gilder, E. (2020). To suction or not to suction; that is the question: Studies of endotracheal suction in post-operative cardiac patients. Doctoral thesis, University of Auckland, Auckland.
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.
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Ingram, L. (2021). There is more than one way of nursing : new graduate nurses' experiences of their first year of practice. Master's thesis, Massey University, Albany.
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.
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Zambas, S. I. (2013). The consequences of using advanced assessment skills in medical and surgical nursing: keeping patients safe. Doctoral thesis, Auckland University of Technology, .
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.
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Evans, S. (2007). Silence kills: Challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16–19.
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.
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Winters, R., & Neville, S. (2012). Registered nurse perspectives on delayed or missed nursing cares in a New Zealand hospital. Nursing Praxis in New Zealand, 28(1), 19–28.
Abstract: Explores the concept of 'missed care' using a qualitative descriptive approach. Interviews 5 registered nurses within a NZ hospital about fluctuations in nursing-skill mix and staffing levels, inconsistent availability of equipment and supplies, and higher patient acuity. Identifies two main categories of missed care and nurses' resulting moral distress
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Blair, K. M. (2006). Recognising the sick patient: An emergency nurses view: A research paper.
Abstract: This paper reports on a literature review that examines how health professionals (mainly nurses) recognise the signs of physical deterioration in their patients. It includes discussion of how nurses' clinical decision making skills influence how physical deterioration is identified and determines what changes in the delivery of care could have an impact on emergency department patients at risk of life threatening deterioration.
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Whitehead, N. (2007). Quality and staffing: Is there a relationship in aged residential care. Master's thesis, , .
Abstract: This thesis reports a mixed methods study, longitudinal in nature, of consenting Age Related Residential Care (ARRC) hospitals in the upper half of the North Island, which was conducted to examine several factors, including AARC hospital efficiency at producing adverse event free days for residents. An interpretativist approach examined what best practice strategies were implemented by the ARRC hospitals that were identified to be most successful at producing adverse event free days for the residents.
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Patel, R. (2021). Patient safety of older adults with cognitive impairment: Evaluation of a service improvement initiative. Master's thesis, Victoria University, Wellington.
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.
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Wynne-Jones, J., Martin-Babin, M., Hayward, B., & Villa, L. (2020). Patient safety leadership walk-rounds: lessons learrned from a mixed-methods evaluaion. Kai Tiaki Nursing Research, 11(1), 24–33.
Abstract: Assesses the impact of a patient safety leadership walk-rounds (PSLWR) programme in an Auckland hospital to provide recommendations for programme improvement. Involves senior leaders and other departmental representatives visiting wards to conduct staff and patient interviews to capture their experiences, and to assess the environment. Proposes recommendations for organisations intending to or currently implementing a PSLWR programme.
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McBride-Henry, K., & Foureur, M. (2006). Organisational culture, medication administration and the role of nurses. Practice Development in Health Care, 5(2), 208–222.
Abstract: This research study was designed to identify ways of enhancing patient safety during the administration of medications within the New Zealand context. The researchers employed a multi-method approach that included a survey using the Safety Climate Survey tool, focus groups and three clinical practice development groups. The authors conclude that the outcomes of this study indicate that practice development initiatives, such as the ones outlined in this project, can have a positive effect on nurses' perceptions of organisational safety, which in turn has been demonstrated to have a positive impact on patient safety.
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Lim, A. G., North, N., & Shaw, J. (2014). Nurse prescribing : the New Zealand context. Nursing Praxis in New Zealand, 30(2), 18–27.
Abstract: Examines the introduction of nurse prescribing in NZ with respect to the level of knowledge and skills required of practitioners for safe prescribing. Compares experiences in NZ with those in the US, UK, and Canada. Critiques the higher educational model as the standard for preparation to prescribe, while supporting alternative models for extending prescribing rights.
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