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.
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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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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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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Beaver, P. J. (2015). Contemporary patient safety and the challenges for New Zealand. Ph.D. thesis, University of Auckland, .
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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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.
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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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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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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Börner, H. E. (2008). Evaluating safe patient handling systems: Is there a better way? Ph.D. thesis, , .
Abstract: This observational study analyses the responses of 38 nurses from two similar units that use different patient handling systems to test the reliability and validity of the Safe Patient Handling Survey (TM) SPH Survey(TM), a perception survey and improvement tool for employees and employers. Currently there is a lack of tools for evaluating patient handling systems. The survey contains 55 questions divided into 6 clusters, staff and patient injury and violence questions, and picture questions depicting unsafe techniques. The data were analysed to see how the SPH Survey(TM) scores correlate with incidents, and its ability to detect differences between the two units. The results of the Pearson and Cronbach(TM) alpha tests show strong reliability, validity and consistency of the SPH Survey(TM). ANOVA comparison of means and Spearman(TM) rho tests shows that higher (better) scores on the SPH Survey(TM) clusters correlate with lower numbers of patient injuries, lower reports of verbal and physical violence episodes, and lower staff injuries. Differences were detected between the units with Unit 2 scoring higher than Unit 1 in all SPH Survey(TM) clusters and scoring lower in staff and patient injuries and violence incidents. Although the analysis was limited by the small sample size, the study has created a sound basis for further investigation. The SPH Survey(TM) is shown to be an easy way to reliably evaluate patient handling systems and workplace culture, target improvement initiatives, and continually monitor the level of patient handling risk in the workplace. Low-risk patient handling gives health care providers the means to focus on delivering high quality patient care, without endangering their own health and well-being.
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Fairhall, M. (2008). An observational study of Peripherally Inserted Central Cather(PICC)-related complications amongst oncology patients. Ph.D. thesis, , .
Abstract: This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days. Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer. These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate.
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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.
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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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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Rudd, J. (2005). From triage to treatment: An exploration of patient flow systems in emergency departments. Ph.D. thesis, , .
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.
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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 6, 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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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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