Thesis (Ph. D.)--Marquette University, 2009. / Richard Fehring, Margaret Bull, Claudia Nassaralla, Advisors.

M.Cur. (Nursing Science) / The purpose of the research study was to explore and describe the experiences of critical care nurses working in adult critical care units of a private hospital in Gauteng, following their involvement in a sentinel event. This information could enable the researcher to formulate guidelines for support of these nurses. Health care professionals aim to deliver safe, high quality care, but unfortunately, all humans can, and do make mistakes (Wakefield, 2007: 12). Since the report To err is human was released by The Institution of Medicine at Havard University (Kohn, Corrigen & Donaldson,1999), more authors have concluded that it is human to make mistakes (Erasmus, 2008:5). Mistakes in the nursing environment can be seen as sentinel events which could result in unintended harm to the patient (Muller, Bezuidenhout & Jooste, 2006:456). Sentinel events in health care, could lead to the devastating concepts of negligence, malpractice, or unprofessional practice, as nurses are held accountable for their acts and omissions according to Erasmus (2008: 5-6). The following research questions emerged:  What are the experiences of critical care nurses, following their involvement in a sentinel event, which harmed, or could have resulted in unintended harm to the patient?  What guidelines for support of these nurses could be formulated? This study was planned in two phases and the objectives of the study were: Phase 1: To explore and describe the lived experiences of nurses, working in the adult critical care units in a private hospital in Gauteng, following their involvement in a sentinel event, which harmed, or could have resulted in unintended harm to the patient. Phase 2: To formulate guidelines for support of these nurses, following their involvement in a sentinel event. A qualitative, exploratory, descriptive and contextual phenomenological research design was used to gain more information regarding critical care nurses` lived experiences, following their involvement in a sentinel event. The study was done in two adult critical care units, in a private hospital in Gauteng. Data was collected by means of six individual in - depth interviews and three naive sketches. Data analysis was done according to Tesch`s open-coding qualitative data analysis method (Creswell, 2007:156). Two main categories emerged from the data, namely the nurses` experiences following their involvement in a sentinel event and the recommendations towards guidelines for support of these nurses. The first main category was sub categorized as being personal, emotional, social and professional experiences and were found as being positive, as well as negative experiences. In the second main category, recommendations towards guidelines for support of nurses, following their involvement in a sentinel event, were proposed and these recommendations were sub- categorised as being at a personal, professional and organizational level of the nurse. In view of the findings of this study, the recommended guidelines for support of nurses, following their involvement in a sentinel event included communication, debriefing, in-service training, root cause analysis and organizational support. Consequently, the intent should be to implement these proposed guidelines for support in the hospital under study. If nurses were supported to follow these guidelines, it may help the nurses who had been involved in a sentinel event, to restore their strive for wholeness in body mind and spirit (University of Johannesburg, 2009:1) and these nurses could be able to render holistic nursing care.

Submitted in Fulfillment of the Requirements of the Degree of Doctor of Technology: Nursing Sciences, Durban University of Technology, Durban, South Africa, 2012. / Introduction While investigating alleged unprofessional conduct involving nurses, SANC collects a wealth of information which is used as the basis upon which to determine the nurses’ guilt or innocence in respect of unprofessional conduct. No evidence exists that such information is ever used to determine how similar acts of unprofessional conduct could be prevented and/or be used in mitigating the impact of such acts on patient safety. Given that nurses have most interaction with patients, there is much to learn from practice breakdown involving nurses. Methods A four phase cross sectional sequential exploratory mixed method approach using a modified soft system methodology (SSM) methodology was utilised to develop a framework for the integrated management of practice breakdown. Purposive sampling was followed to select five districts in KwaZulu-Natal for inclusion in the study. In addition Operational Nursing Managers, members of the Professional Conduct Committee of the South African Nursing Council, and representatives of organised labour were purposively sampled. Qualitative data regarding causes and current practices in the management of practice breakdown in the nursing profession was gathered from key groups via focus groups, and individual phone calls. Then a survey instrument used to test the elements of the emerging theory was developed. Finally, a framework for integrated management of practice errors is suggested. Results The study found that practice breakdown was a product of both environmental factors such as fallible managerial decisions, and unintended acts committed by nurses. In addition, the types of errors and consequences of error management were identified. Finally, conditions requisite for the integrated approach in the management of practice breakdown were identified and used to develop a framework for an integrated approach in the management of practice breakdown in nursing. Conclusion Creation of a positive practice environment for nurses is requisite for an integrated approach in the management of practice breakdown. / Appendices only available in the Hard copy of the Thesis / D

South African hospitals, as a result of numerous factors, have the problem of an increasing workload for nursing staff, which in turn may affect patient treatment quality. This project aimed at addressing patient treatment quality specifically from the perspective of worker capabilities by investigating the strain level and predicted human error probability associated with specific patient-centered tasks in the South African health care sector. This was achieved through two independent yet interlinked studies which focused on seven patient-centred tasks. The tasks analysed were the tasks of setting up and changing intravenous medication, administering injection and pill medication, measuring blood glucose, temperature and heart rate and blood pressure. In the first study, work environment and task characteristics, task structure and execution were analysed. In addition to the task execution, the resulting strain levels, in the form of heart rate measures and subjective ratings of workload, were studied. The second study determined the error protocols and predictive error probability within the healthcare environment for the seven pre-defined tasks. The results for the first study established that different organizational and environment factors could affect task complexity and workload. The individual task components and information processing requirements for each task was also established. For the strain analysis, significant results for the tasks were determined for heart rate frequency and the heart rate variability measures, but some of these were contradictory. For the second study, specific error protocols and error reporting data were determined for the hospital where this research was conducted. Additionally the predictive error probability for the pre-defined tasks was determined. This combined approach and collective results indicate that strain and predictive error probability as a result of task workload can be determined in the field as well as being able to identify which factors have an effect on task strain and error probability. The value of this research lies in the foundation that the gathered information provides and the numerous potential applications of this data. These applications include providing recommendations aimed at improving nursing work environment with regards to workload, improving patient treatment as a result of a reduction in errors and the potential foundation these results provide for future research

Indiana University-Purdue University Indianapolis (IUPUI) / Medication administration error remains a leading cause of preventable death. A gap exists in understanding attentional dynamics, such as nurse situation awareness (SA) while managing interruptions during medication administration. The aim was to describe SA during medication administration and interruption handling strategies. A crosssectional, descriptive design was used. Cognitive task analysis (CTA) methods informed analysis of 230 interruptions. Themes were analyzed by SA level. The nature of the stimuli noticed emerged as a Level 1 theme, in contrast to themes of uncertainty, relevance, and expectations (Level 2 themes). Projected or anticipated interventions (Level 3 themes) reflected workload balance between team and patient foregrounds. The prevalence of cognitive time-sharing during the medication administration process was significant or may be remarkable. Findings substantiated the importance of the concept of SA within nursing as well as the contribution of CTA in understanding the cognitive work of nursing during medication administration.

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates