Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

Thesis (M. Nurs.)--University of Hong Kong, 2002. / Title from title frame. Includes bibliographical references (leaves 107-117).

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

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.

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Although promotion of health and healthy lifestyles are accepted tasks of registered nurses, the assessment of nurses' own health and health behaviours has rarely been assessed. In this study questionnaire responses from 59 female registered nurses and interviews with ten nurses employed full-time in south-west Alberta were analyzed. The questionnaire consisted of items taken and adapted from the Canada Health Survey (Health & Welfare Canada, 1981) on subjective well-being (Affect Balance Scale and Health Opinion Survey) and certain lifestyle practices (pap test, breast examination, alcohol consumption, cigarette smoking and seat belt use). A question on leisure time physical activity was take from Godin, Jobin and Bouillon (1986). Questions assessing self-reported immune status and perception of self as a health role model for others were designed by the researcher. Data from the questionnaires were described in narrative, frequency counts and percentages. Comparisons were made among responses in various parts of the questionnaire as well as with the results of the Canada Health Survey. Interview questions designed by the researcher assessed the ways in which the nurse participants thought about health and their goals for health; transcribed interview responses were categorized according to themes; further interpretation was done on three main themes (maintenance of health as a goal, perceived lack of nurses' self-care and nurses' expectations of themselves). The nurses' scores on the Affect Balance Scale and the Health Opinion Survey place them toward the positive end of a positive-negative continuum of subjective well-being (Okun, Stock, Haring & Witter, 1984). Comparison of the participants' responses regarding lifestyle and preventive practices with the Canada Health Survey suggests that these nurses had relatively adequate health practices with the possible exception of participation in vigorous physical activity. A majority of the participants perceived themselves as role models of health, particularly non-smokers and those with post-RN education. The ten interviewed nurses generally gave maintenance of health as their primary present and future goal for health. Lack of self-care was associated by participants with nurses' and women's traditional concern for others before themselves. The participants seemed to have generally high expectations for themselves and other nurses. This descriptive and exploratory study may provide a baseline for future study of nurses' health, an indication of areas for health promotion programs for nurses and a discussion point for nurses to continue to assess their own health and the factors affecting their own health and goals for health. / x, 149 p. ; 28 cm