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

Erro médico é uma importante causa de morte na medicina humana, estimando-se ser a terceira causa de morte nos Estados Unidos. Podemos enquadrar de modo geral os erros em imperícia, imprudência e negligência. Há ainda na medicina humana um impasse ético entre revelar ou não ao paciente e/ou familiares a ocorrência do erro, o qual estudos revelam que divulgar o erro seja o mais apropriado. Observa-se também a importância de erros médicos em medicina veterinária, que apresenta similaridades com os casos humanos. Tanto em medicina humana quanto em veterinária o profissional envolvido em erro pode responder juridicamente nas esferas civil e/ou criminal. O Código de Ética do Médico Veterinário do CFMV, no artigo 14 inciso I prevê a responsabilização do médico veterinário em casos de imprudência, imperícia e negligência. O profissional da saúde deve sempre atualizar seus conhecimentos, a fim de se evitar a ocorrência de casos de erro médico. Especificamente no que diz respeito ao diagnóstico, a depender da natureza da enfermidade e resposta do organismo do paciente frente a doença, não há obrigatoriedade do profissional no acerto, mas sim na utilização de todos os meios disponíveis para se chegar ao diagnóstico, sempre em comum acordo com o proprietário. Dada a maior demanda tanto de atendimento médico veterinário, pela maior expectativa de vida dos pacientes e maior preocupação dos proprietários em fornecer os cuidados médico veterinários devidos, quanto pela crescente ocorrência de processos judiciais contra os profissionais envolvidos em casos suspeitos de erro, há a necessidade de se desenvolver estudos multidisciplinares nas esferas médico veterinária, jurídica e da relação proprietário-médico veterinário. Assim, este estudo levantou os casos de erro médico veterinário com foco nos erros em diagnóstico da casuística de necropsia do Serviço de Patologia Animal do Departamento de Patologia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo FMVZ-USP dos anos de 2012 a 2016. Foi analisada a casuística geral e separada a relativa às necropsias documentadas. Os cães forma os animais que apresentaram maior frequência na casuística de erros, tanto na geral quanto de necropsias documentadas. A negligência foi a ocorrência mais frequente, e na casuística geral observou-se uma maior frequência de animais adultos, enquanto nas necropsias documentadas houve mais casos de filhotes. O sistema respiratório se mostrou o mais suscetível a sofrer negligência no diagnóstico clínico, e as doenças mais comumentes negligenciadas são as infecciosas e neoplásicas, respectivamente. Assim, este estudo sugere a necessidade de maior atenção por parte dos médicos-veterinários quanto à anamnese e exame físico, que devem ser cuidadosos, bem como a solicitação adequada de exames complementares necessários para uma abordagem diagnóstica efetiva. / Medical malpractice is an important cause of death in human medicine, estimating to be the third leading cause of death in the United States. We can generally frame errors in incompetence, imprudence and negligence. There is still in human medicine an ethical impasse between revealing or not to the patient and / or relatives the occurrence of the error, which studies reveal that disclosing the error is most appropriate. It is also observed the importance of medical errors in veterinary medicine, which presents similarities with human cases. In both human and veterinary medicine, the professional involved in error may be legally blamedin the civil and/or criminally. The Code of Ethics of the Veterinarian, in article 14, section I provides for the responsibility of the veterinarian in cases of incompetence, imprudence and negligence. The health professional should always update his knowledge in order to avoid the occurrence of cases of medical malpractice. Specifically regarding the diagnosis, depending on the nature of the disease and the response of the patient\'s body to the disease, there is no obligation on the professional to correct it, but on the use of all available means to arrive at the diagnosis, always in common according to the owner. Given the greater demand for both veterinary care, longer patient life expectancy, and greater concern of owners to provide due veterinary care, and the increasing occurrence of legal proceedings against professionals involved in suspected cases of error, there is a need to develop multidisciplinary studies in the veterinary, legal and veterinary-veterinarian relations. Thus, this study has raised the cases of veterinary error with focus on errors in the necropsy diagnosis of the Animal Pathology Service of the Department of Pathology of the Faculty of Veterinary Medicine and Animal Science of the University of São Paulo - FMVZ-USP for the years 2012 to 2016. We analyzed the general and separate case series on documented necropsies. Dogs form the animals that presented the highest frequency in the series of errors, both in general and documented necropsies. Neglect was the most frequent occurrence, and in the general casuistry a greater frequency of adult animals was observed, whereas in documented necropsies there were more cases of pups. The respiratory system has been shown to be most susceptible to negligence in clinical diagnosis, and the most commonly neglected diseases are infectious and neoplastic, respectively. Thus, this study suggests the need for greater attention on the part of the veterinarians regarding anamnesis and physical examination, which should be careful, as well as the appropriate request for complementary tests necessary for an effective diagnostic approach.

The hippocratic principle "primum non nocere" (above all do no harm) has always been and still is the strong foundation of medical conduct. For a long time healthcare professionals created the image of infallibility of medicine. Even within the "closed" hierarchies mistakes and malpractice were never openly discussed. This paper first investigates reasons for medical mistakes and introduces the legislation when malpractice occurs. Secondly ethical questions concerning medical mistakes are discussed through the lens of Beauchamp and Childress' principles of biomedical ethics (nonmaleficence, beneficence, respect for autonomy, justice). Thirdly, an ethically defensible strategy to deal with failure and malpractice is proposed. This proposal stresses how to improve the patient-physician communication by involving patients' experiences in order to increase patient safety and lower costs in the healthcare system. In regard to tackling medical harm there is the strong recommendation to follow four directives: open disclosure and explanation, adequate restorative and/or compensatory actions, fair and square apologies and information about strategies to avoid recurrence.

Erro médico é uma importante causa de morte na medicina humana, estimando-se ser a terceira causa de morte nos Estados Unidos. Podemos enquadrar de modo geral os erros em imperícia, imprudência e negligência. Há ainda na medicina humana um impasse ético entre revelar ou não ao paciente e/ou familiares a ocorrência do erro, o qual estudos revelam que divulgar o erro seja o mais apropriado. Observa-se também a importância de erros médicos em medicina veterinária, que apresenta similaridades com os casos humanos. Tanto em medicina humana quanto em veterinária o profissional envolvido em erro pode responder juridicamente nas esferas civil e/ou criminal. O Código de Ética do Médico Veterinário do CFMV, no artigo 14 inciso I prevê a responsabilização do médico veterinário em casos de imprudência, imperícia e negligência. O profissional da saúde deve sempre atualizar seus conhecimentos, a fim de se evitar a ocorrência de casos de erro médico. Especificamente no que diz respeito ao diagnóstico, a depender da natureza da enfermidade e resposta do organismo do paciente frente a doença, não há obrigatoriedade do profissional no acerto, mas sim na utilização de todos os meios disponíveis para se chegar ao diagnóstico, sempre em comum acordo com o proprietário. Dada a maior demanda tanto de atendimento médico veterinário, pela maior expectativa de vida dos pacientes e maior preocupação dos proprietários em fornecer os cuidados médico veterinários devidos, quanto pela crescente ocorrência de processos judiciais contra os profissionais envolvidos em casos suspeitos de erro, há a necessidade de se desenvolver estudos multidisciplinares nas esferas médico veterinária, jurídica e da relação proprietário-médico veterinário. Assim, este estudo levantou os casos de erro médico veterinário com foco nos erros em diagnóstico da casuística de necropsia do Serviço de Patologia Animal do Departamento de Patologia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo FMVZ-USP dos anos de 2012 a 2016. Foi analisada a casuística geral e separada a relativa às necropsias documentadas. Os cães forma os animais que apresentaram maior frequência na casuística de erros, tanto na geral quanto de necropsias documentadas. A negligência foi a ocorrência mais frequente, e na casuística geral observou-se uma maior frequência de animais adultos, enquanto nas necropsias documentadas houve mais casos de filhotes. O sistema respiratório se mostrou o mais suscetível a sofrer negligência no diagnóstico clínico, e as doenças mais comumentes negligenciadas são as infecciosas e neoplásicas, respectivamente. Assim, este estudo sugere a necessidade de maior atenção por parte dos médicos-veterinários quanto à anamnese e exame físico, que devem ser cuidadosos, bem como a solicitação adequada de exames complementares necessários para uma abordagem diagnóstica efetiva. / Medical malpractice is an important cause of death in human medicine, estimating to be the third leading cause of death in the United States. We can generally frame errors in incompetence, imprudence and negligence. There is still in human medicine an ethical impasse between revealing or not to the patient and / or relatives the occurrence of the error, which studies reveal that disclosing the error is most appropriate. It is also observed the importance of medical errors in veterinary medicine, which presents similarities with human cases. In both human and veterinary medicine, the professional involved in error may be legally blamedin the civil and/or criminally. The Code of Ethics of the Veterinarian, in article 14, section I provides for the responsibility of the veterinarian in cases of incompetence, imprudence and negligence. The health professional should always update his knowledge in order to avoid the occurrence of cases of medical malpractice. Specifically regarding the diagnosis, depending on the nature of the disease and the response of the patient\'s body to the disease, there is no obligation on the professional to correct it, but on the use of all available means to arrive at the diagnosis, always in common according to the owner. Given the greater demand for both veterinary care, longer patient life expectancy, and greater concern of owners to provide due veterinary care, and the increasing occurrence of legal proceedings against professionals involved in suspected cases of error, there is a need to develop multidisciplinary studies in the veterinary, legal and veterinary-veterinarian relations. Thus, this study has raised the cases of veterinary error with focus on errors in the necropsy diagnosis of the Animal Pathology Service of the Department of Pathology of the Faculty of Veterinary Medicine and Animal Science of the University of São Paulo - FMVZ-USP for the years 2012 to 2016. We analyzed the general and separate case series on documented necropsies. Dogs form the animals that presented the highest frequency in the series of errors, both in general and documented necropsies. Neglect was the most frequent occurrence, and in the general casuistry a greater frequency of adult animals was observed, whereas in documented necropsies there were more cases of pups. The respiratory system has been shown to be most susceptible to negligence in clinical diagnosis, and the most commonly neglected diseases are infectious and neoplastic, respectively. Thus, this study suggests the need for greater attention on the part of the veterinarians regarding anamnesis and physical examination, which should be careful, as well as the appropriate request for complementary tests necessary for an effective diagnostic approach.

The Crimes Act 1961 and the New Zealand Bill of Rights Act 1990 provide that a person accused of a criminal offence in New Zealand has the right to be represented at trial by counsel. The purpose of representation by counsel is to protect the accused�s interests; ensure that the accused is able to present their defence to the Court; ensure that the accused receives a fair trial; and ensure that the accused is not the subject of a miscarriage of justice. It is implicit that criminal defence counsel must be competent if they are to be effective advocates on behalf of their clients. If counsel is not competent, there is a risk that counsel�s acts or omissions may cause or contribute to a miscarriage of justice. The Crimes Act 1961 allows an accused to appeal against their conviction on the basis that they have been the subject of a miscarriage of justice through the conduct of their counsel. The thesis analyses the Supreme Court decision of R v Sungsuwan that sets out the test that an appellate court must consider when deciding to allow an appeal based on the conduct of counsel. The thesis examines 239 Court of Appeal decisions between 1996 and 2007 that have considered appeals from jury trials where at least one of the grounds of appeal was that defence counsel caused or contributed to a miscarriage of justice. The thesis notes the increasing trend to use "conduct of counsel" as a ground of appeal. In 1996 there were 4 appeals; in 2006 there were 43 such appeals and in 2007 there were 29 appeals. During the period under review the Court of Appeal allowed the appeal and specifically held that counsel�s conduct, either alone or in combination with other grounds, caused or contributed to a miscarriage of justice in 41 cases. The thesis analyses the common complaints made by an accused against trial counsel and the common areas where the Court of Appeal upheld complaints against counsel. The thesis takes into account the Lawyers and Conveyancers Act 2006 and the Lawyers and Conveyancers (Lawyer: Conduct and Client Care) Rules 2008 that came into existence on 1 August 2008. The new legislation places particular emphasis on the obligations of counsel to uphold the rule of law and to facilitate the administration of justice in New Zealand. Counsel also has an obligation to protect the interests of their clients. The thesis concludes that the plethora of cases coming before the Court of Appeal, and the number of appeals allowed by the Court, demonstrate defence counsel do not always protect the interests of their clients and can cause or contribute to a miscarriage of justice. The thesis makes a number of recommendations that may reduce the risk of both an accused appealing on the basis on the conduct of counsel and an appeal being allowed on the basis of the conduct of counsel. In particular, it is suggested that there should be greater degree of co-operation between the New Zealand Law Society and the Legal Services Agency to ensure the maintenance of high standards among criminal defence lawyers.

This study explores resolution mechanisms for all types of medical malpractice cases with a special focus on the patients and their families¡¦ subjective experiences in such disputes, as well as the relevant factors that influence the process of decision-making and the relevant results. The previous studies on patients¡¦ actions to medical disputes in the literature assumed that patients and their families took certain actions due to monetary reasons or discriminated status under a restricted medical system. Most studies simply state the variables that led the patients and their families to certain resolution mechanism. Nevertheless, not many researchers have explored the micro experiences of meaning construction during the process to resolve malpractice cases. Neither did they study how the patients interpret the cultural and structural variables, which might result in different dispute resolution mechanism being used. Therefore, this study attempts to develop a tentative approach to integrate macro and micro analyses and take the advantage of the procedure of grounded theory to explore the dynamic process in the resolution of disputes over medical malpractice. In-depth interviews were applied in the study involving 16 patients and their family members, 13 third party groups and two physicians for a total of 31 people. Among the 16 patients and their family members, there were 14 cases of medical treatment dispute. It was found that the core concept of ¡§admitting a mistake was made¡¨ is the main goal of patients and their family members when dealing with the dispute. If the injury is not critical, normally the physician will admit his/her mistake in the beginning of the dispute. If the injury is critical, since the patients and their family members not having professional knowledge regarding medical injury and their social economical status as well as lower mobilization capabilities than physicians, they do not get an apology or the truth regarding the medical injury. They only receive compensation at most. There are two key causes of providing compensation: (a) crisscrossed interpersonal connection between patient, physician and the third party, such as a civil representative, who plays the role of coordinator; (b) after litigation, usually the court prosecutor or the judge will mediate between the patient and physician, so that compensation can be made. No direct judgment is made. Yet the patients and their family members are not satisfied because they do not receive a response from the involved physician regarding their request about ¡§admitting mistake was made¡¨ which is terminated since their is no money for further litigation, pressure from the civil representative or other objections of the family members. Furthermore, the interview of the third party and the involved physician show that public hospitals are more afraid of irrational acts from patients and their family members or the intervention of the civil representative when dealing with medical disputes. Even if there is no medical negligence, they still submit to the requests of the patients and their family members.

M. Tech. Architectural Technology / The research is focused on professional indemnity insurance for architects in Namibia. Professional indemnity insurance is not currently provided for in both the Architects' and Quantity Surveyors Act (Act 13 of 1979) of Namibia, or contracts used by architects in Namibia. The absence of professional indemnity insurance in contracts used by the Namibian built environment must be addressed, in order to create awareness of the risks involved in practising without professional indemnity insurance. This study will contribute to the knowledge of architectural practise in Namibia by emphasising the evident gaps in the existing contract data, namely the Architect's and Quantity Surveyor's Act (Act 13 of 1979) and the Client Architect Agreement of the Namibia Council for Architects and Quantity Surveyors. It is envisioned that passing a bill in parliament, making professional indemnity insurance compulsory for all registered professionals, will benefit the Namibian architectural environment. An applied research model is selected by implementing triangulation. The approach starts broadly in the architectural environment of Namibia, addressing issues of contracting and governing legislations, before focusing specifically on professional indemnity insurance and the need for it in the Namibian built environment.

No description available.

The aim of this study was to document the safeguards inherent in the Mental Health Act (MHA) of 1973, and to examine the extent " to which these are observed in practice. The research was conducted at Lentegeur Hospital in Mitchells Plain, Cape Town. The population consisted of 726 certified patients who were admitted involuntarily (i.e. under sections 9 and 12 of the MHA) from 01 January 1990 to 31 December 1990. Data for each of these patients was collected from the admission register, clinical files, administrative files, and the certified post book. In addition, the official hospital statistics were examined. Measurements obtained included demographic data, the validity of the document contents, the validity of the certification process, and an overall measure of the validity of each of t he certifications taking into account both document contents and observance of the time strictures set out in the MHA. Twenty nine patients (4,0%) were admitted by Urgency (Section 12), and 697 (96,0%) on Reception Order (Section 9). The study focused mainly on the Section 9 patients, because of the small sample size for Urgency admissions. It was found that 609 (87,4%) of the 697 admissions were legally flawed in terms of document contents criteria and the time limits in the certification process. Document content criteria were not fulfilled in: 3,0% of the Applications for Reception Order; 32,1% of Medical Certificates; 20,1% of Reception Orders; and 3,6% of Reports to the Attorney-General. In 40,0% of certifications the Report to the Attorney-General (G2/28) could not be traced. Examination of temporal safeguards revealed that the least satisfactory aspect was the delay in the completion of the post-admission Report to the Attorney-General. It was found that 32,3% of these Reports were not submitted on time. Reasons for the discrepancy ("gap") between legal standards and actual practice are discussed. Recommendations are made which could help minimise or eradicate this "gap". These include suggestions for changes in the document format, for the use of a certification booklet, for stricter control of late and inadequate documentation, and for inservice training of all those involved in the certification process. / Thesis (M.Med.)-University of Natal, Durban, 1993.

In this paper, I use data from the Florida Closed Claims Database to investigate how Florida’s 2003 non-economic damage cap legislation impacted elderly malpractice claimants. More specifically, I measure whether or not non-economic damage caps adversely impact claimants in counties with high elderly densities. To measure the effect of Florida’s non-economic damage caps, I look at multiple metrics that measure both elderly claimants’ monetary gains and their access to the justice system after the reform is passed. I find mildly conclusive evidence that counties with higher elderly density, and assumedly more elderly claimants, are more likely to settle cases before reaching a jury trial and are less likely to file a medical malpractice claim. Conversely, though, I find limited evidence supporting the idea that elderly claimants receive less monetary damage payments or drop cases more. Overall, then, my findings are not consistent with the view that non-economic damage caps significantly discriminate against elderly claimants.