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McCloskey, B. A., & Diers, D. (2005). Effects of New Zealand's health reengineering on nursing and patient outcomes. Medical Care, 43(11), 1140–1146.
Abstract: This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care.
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Horsburgh, M., Merry, A., Seddon, M., Baker, H., Poole, P., Shaw, J., et al. (2006). Educating for healthcare quality improvement in an interprofessional learning environment: A New Zealand initiative. Journal of Interprofessional Care, 20(5), 555–557.
Abstract: This article describes two interprofessional learning modules offered by the Faculty of Medical and Health Sciences at the University of Auckland to undergraduate medicine, nursing and pharmacy students. The modules, 'Maori Health“ and ”Patient Safety", have a focus on quality improvement in healthcare and are used to bring together students for a shared learning programme.The specific dimensions of healthcare quality covered in the programme are: patient safety, equity, access, effectiveness, efficacy and patient-centeredness.
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Beaver, P. J. (2015). Contemporary patient safety and the challenges for New Zealand. Ph.D. thesis, University of Auckland, . Retrieved May 4, 2024, from http://hdl.handle.net/2292/28247
Abstract: Outlines the history, emergence, necessity, challenges, and strategies of the patient safety movement. Explores the challenges for staff working to reduce harm and implement safety improvement in NZ hospitals. Considers medical harm as a persistent and expensive threat to public health. Analyses health policy in the US, England and NZ using the theory of countervailing powers, and a shift from medical to managerial dominance. Reviews theories of accidents and risk, and the safety improvement literature. Provides staff perspectives from NZ by means of interviews with doctors, nurses and managers in two hospitals.
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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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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. Retrieved May 4, 2024, from https://hdl.handle.net/2292/54764
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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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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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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Wailling, J. (2016). How healthcare professionals in acute care environments describe patient safety: a case study. Master's thesis, Victoria University of Wellington, Wellington. Retrieved May 4, 2024, from http://hdl.handle.net/10063/6242
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.
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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, . Retrieved May 4, 2024, from http://hdl.handle.net/10292/6960
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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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. Retrieved May 4, 2024, from http://hdl.handle.net/10179/17143
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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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. Retrieved May 4, 2024, from http://hdl.handle.net/10063/6197
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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Eton, S. J. (2020). Clinical handover from the operating theatre nurse to the post anaesthetic care unit nurse: a New Zealand perspective. Master's thesis, University of Otago, Christchurch. Retrieved May 4, 2024, from http://hdl.handle.net/10523/10582
Abstract: Presents findings from a study of nurse-to-nurse handover in the perioperative care setting. Describes current practices in nurse handover and surveys theatre and post-anaesthetic-care nurses from around NZ about their satisfaction with handover and whether it affects patient outcomes.
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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. Retrieved May 4, 2024, from https://figshare.com/articles/thesis/Patient_Safety_of_Older_Adults_with_Cognitive_Impairment_Evaluation_of_a_Service_Improvement_Initiative/14214473 Victoria University of 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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Teunissen, C., Burrell, B., & Maskill, V. (2020). Effective surgical teams: an integrative literature review. Western Journal of Nursing Research, 42(1). Retrieved May 4, 2024, from http://dx.doi.org/https://doi.org/10.1177/0193945919834896
Abstract: Evaluates the aids and barriers for perioperative teams in functioning effectively, preventing adverse events, and fostering a culture of safety. Undertakes an integrative review of the literature. Highlights the role of theatre nurses in situational awareness (SA), running the theatre and assuming leadership of the team.
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McBride-Henry, K., & Foureur, M. (2007). A secondary care nursing perspective on medication administration safety. Journal of Advanced Nursing, 60(1), 58–66.
Abstract: This paper reports on a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, or undermine, safe practice during this process. Data were collected in 2005 using three focus groups of nurses that formed part of a larger study examining organisational safety and medication administration from a nursing perspective. A narrative approach was employed to analyse the transcripts. Participants had good understandings of organisational culture in relation to medication safety and recognised the importance of effective multi-disciplinary teams in maintaining a safe environment for patients. Despite this, they acknowledged that not all systems work well, and offered a variety of ways to improve current medication practices. These findings highlight the meaningful contribution nurses can make to patient safety and emphasise the importance of including the nursing voice in any quality improvement initiatives.
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