The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.

The ethics and practical importance of defining, distinguishing and disclosing nursing errors : a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.

Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

Clinical risk management and patient safety education for nurses : a critique

Nurses have a pivotal role to play in clinical risk management (CRM) and promoting patient safety in health care domains. Accordingly, nurses need to be prepared educationally to manage clinical risk effectively when delivering patient care. Just what form the CRM and safety education of nurses should take, however, remains an open question. A recent search of the literature has revealed a surprising lack of evidence substantiating models of effective CRM and safety education for nurses. In this paper, a critical discussion is advanced on the question of CRM and safety education for nurses and the need for nurse education in this area to be reviewed and systematically researched as a strategic priority, nationally and internationally. It is a key contention of this paper that without ‘good’ safety education research it will not be possible to ensure that the educational programs that are being offered to nurses in this area are evidence-based and designed in a manner that will enable nurses to develop the capabilities they need to respond effectively to the multifaceted and complex demands that are inherent in their ethical and professional responsibilities to promote and protect patient safety and quality care in health care domains.

An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context

Cultural safety has been promoted by its New Zealand proponents as an effective process for managing cultural risk in health care and improving the cultural responsiveness of mainstream health services when delivering care to culturally diverse populations. Its effectiveness in this regard has not, however, been comprehensively investigated. A key purpose of this study was to explore and describe what is known and understood about the notion of cultural safety and its possible application to and in Australian health care domains. Findings from the study indicate that the notion of cultural safety is conceptually problematic, poorly understood, and underresearched and, unless substantially revised, cannot be meaningfully applied to the cultural context of Australia.

Creating collaborative spaces : the pleasures and perils of doing multi-disciplinary, multi-partner qualitative research

This paper describes our experience of managing a two-year research project that involved University staff from two different disciplines and three industry partners. It describes the benefits we gained from the involvement of multiple parties, such as the ability to call upon diverse expertise, the capacity to study a complex issue and the ability to make a direct contribution to industry practice. It also describes some of the difficulties such as managing across University structures, maintaining the collaborators' interest in the project, gaining approval from multiple ethics committees and managing the expectations of various stakeholders. The paper concludes with a number of recommendations for senior University staff and for researchers and points to ways universities could better facilitate involvement in these types of complex research projects.

Registered and enrolled nurses : experiences of ethical issues in nursing practice

Research aims:
To explore and describe registered and enrolled nurses’ experiences of ethics and human rights issues in nursing practice in the Australian State of Victoria.

Method:
Descriptive survey of 398 Victorian nurses using the Ethical Issues Scale (EIS) survey questionnaire.

Major findings:
The most frequent and most disturbing ethical issues reported by the nurses surveyed included: protecting patients’ rights and human dignity, providing care with possible risk to their own health, informed consent, staffing patterns that limited patient access to nursing care, the use of physical/chemical restraints, prolonging the dying process with inappropriate measures, working with unethical/impaired colleagues, caring for patients/families who are misinformed, not considering a patient’s quality of life, poor working conditions.

Conclusions:
Nurses in Victoria frequently experience disturbing ethical issues in nursing practice that warrant focussed attention by health service managers, educators and policy makers.

Ethical issues in the recruitment and retention of graduate nurses : a national concern

Australia like other countries is facing a crisis in the recruitment and retention of nurses. Adding to this crisis is the insufficient supply of new graduate nurses to meet current and future workforce demands. Unless changes are implemented that will bring likely demand and supply into balance, it is predicted that by the year 2010 (just seven year away) there will be a shortage of 40,000 nurses in Australia. Significantly, the current shortage of nurses is seeing hospitals, regions, States and countries compete fiercely with each other as they strive to recruit and retain sufficient numbers of nurses to meet their work force needs. The recruitment and retention strategies used by some prospective employers, however, have been highly questionable and raise serious questions about the ethics of nurse recruitment. In response to the issues raised, it is a key recommendation of this paper that mechanisms, including a national code of practice, need urgently to be put in place to ensure the effective, equitable and ethical regulation and monitoring of nurse recruitment and retention in Australia.

Social identities and law students' writing

This paper argues that social identities, discursively speaking, consist of ‘positions’ that are individuated by distinctive linguistic features. These include distinctive patterns of representation indicated by clause structure and type, a set of priorities for attending to what is important indicated by thematic structure, and an orientation to the represented world and to self as indicated by modality, propositional attitudes and tense. A social identity comprises an array of these often contradictory ‘positions’ associated with a social or professional role. A person’s identity is constituted dynamically by the way they ‘reconcile’ the various positions that make up the social identity, and also, as Archer and Ivanic argue, by the way they reconcile a social with a personal or autobiographical identity. It is argued that this process of reconciliation gives clues about identity formation in the traces it leaves in grammatical texture.

This paper uses a simulated letter of advice to a client written by a group of first year law students to explore the discursive construction of social or professional identity. This letter is poorly written and full of grammatical mistakes and infelicities. It is argued that the mistakes provide a linguistic trace of the students’ struggle to reconcile the conflicting roles and positions they occupy as authors of the letter. In particular the students’ problems result from a struggle to reconcile their multiple positions as: students writing for assessment by a tutor about a legal problem, as a simulated firm of solicitors advising to a client, and as potential litigators anticipating the future course of events in their simulated moot court appearance.

PTSD symptomatology in children and adolescents : treatment development and evaluation

This thesis developed, implemented and evaluated a cognitive-behavioural group treatment programme for children and adolescents experiencing symptoms of PTSD (Post-traumatic stress disorder). Results of the study indicate that symptoms of sleep disturbance and flashbacks, reduced markedly in the participants, providing a useful tool in reducing synptoms experiences by individuals exposed to trauma. The Professional portfolio presents four case studies that demonstrate the clinical application of the affect of chronic illness on the psychological adjustment of the sufferer and their families.