Organizational factors: impact on administration violations in rural nursing

AIM: This paper reports a study investigating organizational factors contributing to procedural violations by nurses during medication administration. BACKGROUND: Health care is not as safe as it could be, with research indicating that errors involving medications are a leading cause of unintended harm to patients. In the safety literature, strong claims are made about the connection between violation of procedures and adverse occurrences but, in the healthcare field in particular, there is limited empirical evidence that can serve as a basis for understanding why workers deviate from established procedures. METHOD: Quantitative and qualitative data were collected by questionnaire in 2002 to 627 nurses working in rural and remote areas in Queensland, Australia. The response rate was 31%. The data were used to build a model that shows how organizational variables can produce conditions that improve work practices that fall short of best practice standards. RESULTS: The statistical model accounted for a reliable 19% of the variance in self-reported violations. A higher level of knowledge was found to be associated with lower levels of violations. Conversely, higher workloads and higher expectations by doctors were associated with a higher incidence of violations. Qualitative comments tended to support the conclusions drawn from the model and helped to explain the observed associations. CONCLUSIONS: Attempts to deal with deviations from work procedures through interventions such as retraining or disciplinary action are likely to be ineffective unless they take a more holistic management approach aimed at the individual, the team, the task, the workplace, and the institution as a whole and are directed at the weaker points in the system. These interventions may take the form of training programmes, systems redesign, or the injection of resources. The costs of providing adequate resources to a healthcare system are likely to be offset by savings gained through worker productivity, and better patient outcomes.     

The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars

In conjunction with other health professionals, doctors believe they play an important role in promoting breastfeeding to women. Although many have positive breastfeeding attitudes, significant knowledge deficits often limit their capacity to effectively encourage, support and assist breastfeeding women and their infants. Personal breastfeeding experience (of self or partner) may be the main source of breastfeeding knowledge and skill development and is related to improved knowledge, more positive attitudes and greater confidence. This paper describes the relationship between the cumulative length of personal breastfeeding experience and the breastfeeding knowledge and attitudes of a cohort of Australian general practice (GP) registrars, as well as their confidence and perceived effectiveness assisting breastfeeding women. The Australian Breastfeeding Knowledge and Attitude Questionnaire containing demographic items, a 20-item attitude scale and a 40-item knowledge scale was distributed between February and May 2007 to Australian GP registrars in their final year of training. Participants with more than 52-week cumulative personal (self or partner) breastfeeding experience had the highest mean knowledge score, had more positive attitudes, and were more confident and effective than all other participants. Parents with limited personal experience (相似文献   

Cold Storage Preservation and Warm Ischaemic Injury to Isolated Arterial Segments: Endothelial Cell Injury

Injury to endothelial cells is thought to be important to the development of the vascular lesion of chronic rejection. It was the aim of this study to develop a semiquantitative method to assess endothelial injury in arterial grafts and to document the injury produced by cold storage preservation and additional warm ischaemia. Twelve- and 24-h cold preservation of rat aortic segments, together with an additional 1 h of warm ischaemia, were assessed. Electron micrographs of representative endothelial cells were scored for cytoplasmic, nuclear and mitochondrial injury. The overall injury score was obtained by addition of the individual scores. Storage for up to 24 h in University of Wisconsin (UW) and Terasaki did not produce any injury. Twenty-four hours of storage in Euro-Collins resulted in endothelial cell death. Injury occurred after 12 h of storage in Ross, Collins and normal saline, and the injury increased following 24 h of storage. One hour of warm ischaemia did not increase the injury. Injury to endothelial cells varies with the preservation solution used and the time of cold storage, so that both the type of solution and the storage time should be taken into account in clinical studies looking at the influence of cold ischaemia time and graft outcome.     

Effects of size of health service on scope of rural nursing practice

This paper presents the findings of an analysis of the activities of rural nurses from a national audit of the role and function of the rural nurse (Hegney, Pearson and McCarthy 1997). The results suggest that the size of the health service (defined by the number of acute beds) influences the activities of rural nurses. Further, the study reports on the differences of the context of practice between different size rural health services and the impact this has on the scope of rural nursing practice. The paper will conclude that the size of the health service is an outcome of rurality (small population densities, distance from larger health facilities, lack of on-site medical and allied health staff). It also notes that the size of the health service is a major contextual determinant of patient acuity and staff skill-mix in small rural hospitals, and therefore the scope of rural nursing practice.