Thesis (M. A.)--University of Hong Kong, 2005. / Title proper from title frame. Also available in printed format.

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published_or_final_version / Community Medicine / Master / Master of Public Health

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No description available.

No description available.

The systemic origins of many accidents have led to heightened interest is the way organizations identify and manage risks. The term organizational safety culture' has become common within the literature and seeks to explain the fact that organizations their willingness and ability to conduct safe operations. The activities and stuctures which are thought to represent a °good° safety culture are well documented. However, a model was lacking which would explain the failure of many organizations to develop a organizational culture which would support safety initiatives. Ti thesis seeks to l that gap. A model which aimed to enumerate the factors which impact upon a organizations ability to develop a positive safety culture is presented and tested. A open systems perspective is the development of the model allowed this work to build upon previous treatments of safety culture by incorporating factors within the operating environment. The application of the model is discussed.

Motor vehicle collisions are one of the leading circumstances of death worldwide and are contributory to the second most common circumstance of death in South Africa, “transport-related deaths”. A total of 3248 transport-related deaths were recorded in Gauteng alone in 2009 and for that reason motor vehicle collisions pose a substantial threat to the South African population. This study was undertaken to determine if specific patterns of injuries in victims of fatal motor vehicle collisions existed. For the purposes of this study, “patterns of injury” can be defined as similar injuries of similar severities repeatedly and predictably occurring in similar body regions. The study consisted of all individuals involved in fatal collisions who fit the inclusion criteria during the period between 13 May 2011 and 1 June 2012. The external, visceral, and skeletal injuries sustained by the individuals involved in fatal motor vehicle collisions were observed via x-ray and photographic procedures performed by the investigator, as well as documentation from the Forensic Medical Practitioner/scribe notes. The South African Police Force attending officer’s affidavit and the Johannesburg Metropolitan Police Force Accident Reports were used to determine the make and model of the vehicle, the occupant’s position, type of collision and object with which the vehicle collided. The study’s results indicated that distinct patterns of injuries existed for those individuals involved in fatal motor vehicle collisions. The most frequently observed patterns of injuries included either severe head injuries in isolation, severe thoracic and/or abdominal injuries in isolation, or a combination of the two. Distinct patterns of injuries were noted for individuals occupying different types of vehicles but not for individuals occupying different positions within a single vehicle which is contrary to other international findings.

Nurses espouse a caring ethic and demonstrate effectiveness in prevention of patient falls but are often observed taking risks with patients’ safety. These actions reflect poor congruence between espoused values and behaviours. Attitudes, values and involvement in decision- making are factors that influence work behaviours. Nurses’ attitudes are held to be a definitive factor in prevention work; however, few studies have focused on adherence with best practice principles of fall prevention. Yet nurses claim no authority to change their work. It was assumed that increased adherence would be achieved by improving nurses’ attitudes through participation in decision- making surrounding fall prevention practice. This study aimed to tes t this assumption by empowering nurses working in two medical wards with high numbers of patient falls to improve their ownership of practice by utilising critical social theory and action research. Nurses’ attitudes, including self-esteem, professional values and work satisfaction were established before and after a practice development project using action research. Mixed methods were employed by praxis groups meeting fortnightly for a year reflecting on, and re-engineering practice. Action research occurred in cycles focusing on assessment, communication, everyday work, and performance. Nurses’ work was re-organised to gain time to spend in prevention work. Patients’ environments were made safer and more patient-centred. New and effective ways of assessing risk to fall, communication of risk and monitoring nurses’ performance of prevention work were created and evaluated. Analysis demonstrated that nurses had good self-esteem and professional values but were not satisfied with their work. Self-esteem and professional values were unaffected by participation in work-related decisions however, nurses expressed increased sense of ownership, more satisfaction and were observed to engage in more prevention work. In conclusion, manipulation of attitudes and values is not warranted if attitudes and values are good. However, participation in work-related decision- making engages practitioners and leads to greater congruence between values and behaviour. The “unspoken rules” constraining practice that were exposed in the action research oblige nurses to assume authority, confronting and dispelling these constraints to enable more therapeutic care to emerge. Recommendations include promoting practice development as the preferred means for cultural change and improving person-centred care whilst recognising its fragile nature and dependence on clinical leadership.