Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

This ethnographic study investigated nurses’ experiences of managing nurses and being managed by nurses within the context of a critical care unit. The four specific aims of the study were to: valorise and make space from which nurses could speak of their management perceptions and experiences; investigate and interrogate the cultural practices and knowledges that comprised and reinscribed the discourses of nursing management; identify the marginal, contradictory or subjugated discourses in the form of alternate or oppositional knowledges and practices embedded in nurses’ experience; and reveal how participants were inscribed by or resisted the various discourses, including the multiple and mobile subject positions they adopted. The ethnography was theoretically informed by critical, feminist, and postmodern perspectives. Utilising the strategy of writing from the authorial position of occupying a mobile or nonunitary subjectivity, the research highlighted the methodological tensions so as to struggle for social justice whilst contesting the romance of knowledge as cure (Lather, 2000). Music was metaphorically appropriated to interrupt, subvert, and draw attention to the partial, interpretive, and intertextual nature of ethnographic representation and to represent the feminine other in a thesis normatively privileging written text. Conducted over a period of ten months, direct participant observation, individual interviews, and reflective field notes comprised the data. Eleven registered nurses, from all levels of the nursing hierarchy, participated in the study, in addition to the researcher. The findings of this research revealed nurses experienced feeling abnormal, lonely, angry, and rejected. Interprofessional relations reflected a lack of individual valuing and predominantly vertical violence. Shifting subject positions were primarily informed by dominant instrumental, patriarchal, managerialist, and modernistic discourses that homogenised the identity of nurses and defined the meaning of progress and normal. Management activities were deemed superior to the activities and being of a clinical nurse. Alternate and subjugated discourses included notions of teamwork, equality, mateship, and viewing management as superfluous and contemptuously. Patriarchal behaviours separating personal life from work life were contested, and behaviours often denigrated and stereotyped as female were valued. Valuing and sharing being human within ordinary nursing work, valuing work for the enjoyment of the work itself, and viewing power as with rather than over were further alternate discourses. The major implications from this study for nursing as a profession relate to nurses explicitly and foremost valuing their own practice and fostering a culture that genuinely permits individual diversity to alter the existing pre-scripted relations that constrain nurses’ ability to engage in more meaningful interpersonal relations. Questioning current discourses and practices that value specific economic and scientific knowledges, support patriarchal behaviours, and silence nurses is essential. The articulation of alternative discourses that value women and nursing is crucial for reconstructing a reality that does not result in women and nurses feeling abnormal, rejected, and alienated; particularly within the context of a nursing shortage.

Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury.Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Therefore this research has the potential of informing the speciality practice of acute care pediatric nursing.Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse "works with" the child to maintain and advance medical stability. Nursing interactions are an important part of "working with", communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate.An effective working-relationship with a nurse and family is founded on trust. Trust is an accepted part of our day-to-day lives and how to develop a trusting working-relationship with the child and family has not been explored prior to this research. Grounded theory methods supported the process of exploring the social processes of "building trust" whilst "working with" families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to "work with" and support the re-establishment of the parenting role. The "stepping in and out" of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to "be with", using chat to get to know each other, involving and supporting the family to parent a "different" child and reassuring and giving realistic hope to help the child and parents cope with their changed future.A substantive theory of the concept of "building trust to work with" has been developed using grounded theory methods. The theory has been conceptualized using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

This ethnographic study investigated nurses’ experiences of managing nurses and being managed by nurses within the context of a critical care unit. The four specific aims of the study were to: valorise and make space from which nurses could speak of their management perceptions and experiences; investigate and interrogate the cultural practices and knowledges that comprised and reinscribed the discourses of nursing management; identify the marginal, contradictory or subjugated discourses in the form of alternate or oppositional knowledges and practices embedded in nurses’ experience; and reveal how participants were inscribed by or resisted the various discourses, including the multiple and mobile subject positions they adopted. The ethnography was theoretically informed by critical, feminist, and postmodern perspectives. Utilising the strategy of writing from the authorial position of occupying a mobile or nonunitary subjectivity, the research highlighted the methodological tensions so as to struggle for social justice whilst contesting the romance of knowledge as cure (Lather, 2000). Music was metaphorically appropriated to interrupt, subvert, and draw attention to the partial, interpretive, and intertextual nature of ethnographic representation and to represent the feminine other in a thesis normatively privileging written text. Conducted over a period of ten months, direct participant observation, individual interviews, and reflective field notes comprised the data. Eleven registered nurses, from all levels of the nursing hierarchy, participated in the study, in addition to the researcher. The findings of this research revealed nurses experienced feeling abnormal, lonely, angry, and rejected. Interprofessional relations reflected a lack of individual valuing and predominantly vertical violence. Shifting subject positions were primarily informed by dominant instrumental, patriarchal, managerialist, and modernistic discourses that homogenised the identity of nurses and defined the meaning of progress and normal. Management activities were deemed superior to the activities and being of a clinical nurse. Alternate and subjugated discourses included notions of teamwork, equality, mateship, and viewing management as superfluous and contemptuously. Patriarchal behaviours separating personal life from work life were contested, and behaviours often denigrated and stereotyped as female were valued. Valuing and sharing being human within ordinary nursing work, valuing work for the enjoyment of the work itself, and viewing power as with rather than over were further alternate discourses. The major implications from this study for nursing as a profession relate to nurses explicitly and foremost valuing their own practice and fostering a culture that genuinely permits individual diversity to alter the existing pre-scripted relations that constrain nurses’ ability to engage in more meaningful interpersonal relations. Questioning current discourses and practices that value specific economic and scientific knowledges, support patriarchal behaviours, and silence nurses is essential. The articulation of alternative discourses that value women and nursing is crucial for reconstructing a reality that does not result in women and nurses feeling abnormal, rejected, and alienated; particularly within the context of a nursing shortage.

Thesis (MScFisio)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (156 leaves, ill., 30 cm.) in North Shore Theses Collection. (T 618.920028 HAL)

Dissertation (Ph.D.).--University of Texas Graduate School of Biomedical Sciences at San Antonio, 2006. / Vita. Includes bibliographical references.