If People Were Kaleidoscopes: Sharpening the Resolution on Patient Engagement in Safety

Healthcare is unacceptably error prone. The question remains why, with 20 years of evidence, is error and harm reduction not being effective? While precise numbers may be debated, all stakeholders recognize the frequency of healthcare errors is unacceptable, and greater efforts to ensure safety must occur. In recent years, one of these strategies has been the inclusion of the patient and their family as partners in safety, and has been a required organizational practice of Accreditation Canada in many of their standard sets. Existing patient advisories created to encourage engagement, have typically not included patient perspectives in their development or been comprehensively evaluated. There are no existing tools to determine if and how a patient wants to be involved in safety engagement. As such, a multi-phased study was undertaken to advance our knowledge about the client’s and family’s role in promoting safety. Phase 1 of the study was a scoping review to methodically review the existing literature about patients’ and families’ attitudes, beliefs and behaviours about their involvement in healthcare safety. Phase 2 was designed to inductively explore how a group of patients in an Ontario, Canada, community hospital, describe healthcare safety and see their role in preventing error. The study findings, which include the narratives of 30 patients and 4 family members, indicate that although there are shared themes that influence a patient’s engagement in patient safety, every individual has unique, changing beliefs, experiences and reasons for involvement. Five conceptual themes emerged from their narratives: Personal Capacity, Experiential Knowledge, Personal Character, Relationships, and Meaning of Safety. These study results will be used to develop and test a pragmatic, accessible tool to enable providers a way to collaborate with patients for determining their personal level and type of safety involvement. The most ethical and responsible approach to healthcare safety is to consider every facet and potential way for improvement. This exploratory study provides fundamental insights into the complexity of patient engagement in safety, and evidence for future steps.

Disruptive Threads and Renegade Yarns: Domestic Textile Making in Selected Women's Writing 1811-1925

Images of domestic textiles (items made at home for consumption within the household) and textile making form an important subtext to women’s writing, both during and after industrialization. Through a close reading of five novels from the period 1811-1925, this thesis will assert that a detailed understanding of textile work and its place in women’s daily lives is critical to a deeper understanding of social, sexual and political issues from a woman’s perspective. The first chapter will explore the history of the relationship between women and domestic textile making, and the changes wrought to the latter by the Industrial Revolution. The second chapter will examine the role of embroidery in the construction of “appropriate” feminine gentility in Jane Austen’s Mansfield Park (1814). The third chapter, on Elizabeth Gaskell’s Cranford (1853), will explore how the older female body became a repository for anxieties about class mobility and female power at the beginning of the Victorian era. The fourth chapter will compare Sara Jeannette Duncan’s A Social Departure (1890) and Kate Chopin’s The Awakening (1899) to consider how later Victorian women both internalized and refuted public narratives of domestic textile making in a quest for “self-ownership.” The last chapter, on Martha Ostenso’s Wild Geese (1925), examines the corrosive, yet ultimately redemptive, relationships of a family of women trapped by abuse and degradation. For all five authors, images of textiles and textile making allow them to speak to issues that were usually only discussed within a community of women: sexuality, desire, aging, marriage, and motherhood. In all five works, textile making “talks back” to the power structures that marginalize women, and lends insight into the material and emotional circumstances of women’s lives.