Research suggests that individuals in the workplace might have a difficulty sharing their perceptions of risk and challenging unsafe behaviours. This thesis utilises The Theory of Planned Behaviour to examine which factors promote or hinder healthcare workers’ willingness to speak up and confront clinicians’ risky behaviours that could lead to medical error and hence endanger patient safety. The Theory of Planned Behaviour addresses issues surrounding intentions garnered from explicitly measured variables; in addition the thesis further sought to identify attitudes to speaking up using an implicit measure approach, and an approach using a computerbased, scenario-placement, reaction time methodology. Overall, the results of the thesis’s four studies suggest that nurses’ decisions to speak up are influenced by a variety of negative and positive beliefs. These beliefs include the effect speaking up has on the nurse speaking up and the patient; the support and actions of other nurses and medical personnel; and nurses feelings of confidence, knowledge and experience. Nurses also demonstrated a belief that they are more likely to speak up than their peers. Results also suggested that nurses speak up to individuals that they trust and distrust, indicating that trust and distrust are not polar opposites. The findings suggest that if speaking up is to be promoted practitioners need to address nurses’ negative beliefs—this is especially true with regard to fears about speaking up to authority figures. Nurses stated beliefs that they are more likely to speak up than their peers might be a result of presentation-bias or self-bias, if the cause is self-bias then training nurses to be more assertive and challenge risk might be made more difficult by nurses’ collective denial that they have any difficulties speaking up.

A Research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Bioethics and Health Law. Johannesburg, 2017 / Medical errors that occur in public sector hospitals should be discussed with patients and notified to specific structures to improve systems and patient safety. To elucidate barriers to doctors reporting errors and to establish correct ethical requirements, a mixed methods approach was used. A normative literature-based analysis was done to determine the correct ethical processes taking into account South African legislation. In addition a questionnaire-based internet survey (using REDCap) was conducted at the School of Clinical Medicine (SOCM) at the University of the Witwatersrand which examined the current situation and attitudes towards medical error disclosure. There were 211 clinicians who completed the survey. Public sector hospital staff shortages and patient overloads (96%) as well as poor record-keeping systems (89%) were identified as important reasons for errors. Fears of victimization by colleagues (59%) and medico-legal consequence (56%) were prominent as reasons not to disclose medical errors. Poor reporting systems available to doctors (66%) and insufficient support from senior staff made it difficult for doctors to report errors. Training on correct disclosing of errors to patients and family was seen as necessary to improve skills and facilitate effective disclosure (94%). There was general agreement that doctors 'ought to' disclose harmful medical errors (83%) and to a lesser degree 'potentially harmful' errors to patients (70%). Ethical guidelines that are appropriate for South Africa are suggested, as well as the introduction of easier reporting systems. For disclosure, a safe environment that protects against victimization and medico-legal prosecution is important and legislation to support this is urgently required. Training for doctors in correct methods for adequate disclosure and apology will assist improving patient care. / MT2017

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

Thesis (Ph. D.)--Ohio State University, 2005. / Title from first page of PDF file. Includes bibliographical references (p. 180-184).

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (M.Med.(Orthopaedic Surgery))--University of the Witwatersrand, Faculty of Health Sciences, 2013.

Errors in health care are one of the leading causes of death and injury in this country, requiring new methods for evaluating and promoting quality in health care services. Concern for patient safety, the foundation for quality services, has prompted national initiatives to examine the most basic premise for health care providers: Do no harm to the patient. Few of these initiatives have examined errors from the perspective of those who have been sanctioned for their errors. This descriptive, exploratory study utilized a survey methodology to examine the perceptions of 62 registered nurses (RNs) who had been sanctioned by a board of nursing to ascertain categories of practice errors and identify individual, health care team, patient, and system threats that contributed to an error and/or patient harm. The Threat and Error Management Model (TEMM) was utilized as a framework for examining the phenomena that promote or hinder patient safety. Using a modified version of the Taxonomy of Error Root Cause Analysis of Practice-Responsibilities (TERCAP) instrument, sanctioned RNs selected types of errors associated with a breakdown in their nursing practice. In addition, they identified factors that contributed to their errors, including individual, health care team, patient, and system threats. Associations between the levels of patient harm and types of error were examined. Two open-ended questions provided an opportunity for the participants to describe changes in their practice since the error event. System and health care team factors were the most common items selected as contributing to the error events, while individual factors were the least often selected items. Two types of errors, clinical evaluation and attentiveness/surveillance, were significantly related to the level of harm to patients. Given the opportunity to discuss individual factors through open-ended questions, responses were comprehensive and many were related to issues with trust. Recommendations for nursing theory, policy, practice, education, and research are reviewed.

No description available.

Thesis (M.S.)--Rochester Institute of Technology, 2007. / Typescript. Includes bibliographical references.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (p. 312-325). Also available in print.