- Title
- Nurses’ recognition and response to unsafe practice by their peers
- Creator
- Blair, Wendy
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis is titled ‘Nurses’ recognition and response to unsafe practice in their peers’. Using a mixed methods approach, this study aimed to identify the behaviours and cues that nurses recognised as indicating unsafe practice and the factors which they perceived influenced the occurrence of unsafe practice by their peers. In addition, this study sought to report the actions and responses by nurses when they encountered unsafe practice by their peers. During Phase One a small number of participants were interviewed about their perceptions of working with colleagues they thought were practicing unsafely. Data were analysed using open coding and content analysis and resultant categories included types of unsafe behaviour, intentions and values, cues to identifying unsafe practice, responses to unsafe practice, actions to address unsafe practice, barriers to addressing unsafe practice, enablers for addressing unsafe practice, effects of unsafe practice on patient safety, conditions that create unsafe practice and conditions that promote safe practice. Data from this phase were used in combination with information from relevant literature to develop the survey used in Phase Two of the study. The Phase Two survey collected quantitative data from nurses in New Zealand about organisational practices and policies for the prevention of unsafe practice, identification of the potential for unsafe practice, identification of behaviours and factors associated with unsafe practice, and nurses’ responses to unsafe practice. The prevalence of witnessing unsafe practice in the previous 12 months was similar for nurses and managers, and higher than reported in other studies. All the behaviours in this survey were found to be strongly associated with unsafe practice. Unprofessional behaviour was identified as being related to unsafe practice by the majority of participants. Comparisons between nurses and managers showed that managers had a better understanding of organisational approaches to assessing practice and were more likely to formally report a colleague for unsafe practice. Issues such as poor organisational culture and leadership, inadequate training, workload, staffing and skill mix were identified by both groups as factors that influenced the occurrence of unsafe practice. The rate of reporting unsafe practice was lower than in other studies and the odds of reporting were significantly higher for managers. Participants reported a variety of different responses to witnessing unsafe practice, with the most common action being speaking to the nurse involved. A qualitative-descriptive approach was used to collect and analyse data in Phase Three. Interviews from Phase One and Phase Three were analysed together and data were coded into seven categories and thematically analysed. Final codes were grouped into recognition and responses. Cues to unsafe practices included overconfidence, hiding practice, complacent attitude and approach, scope of practice transgressions, unprofessional behaviour, failure to follow accepted practice standards, poor interpersonal and communication skills, culturally unsafe behaviour and bullying as a precursor. The influence of collegial and organisational culture on the recognition of unsafe practice was also identified. Interview participant responses included the challenge of taking action, watching and waiting (increased vigilance), the influence of a perceived lack of responses, self-monitoring as a response, the effect of collegial and organisational culture on response, and the conditions that influenced responses to unsafe practice. Themes of uncertainty, sensing unsafe practice, and disrupted professionalism emerged from the data analysis. A micro-meso-macro framework was developed to illustrate and evaluate the recognition of, responses to, and influences on unsafe practice, at the level of the individual, team/organisation and the wider health care system. In addition, a critical realist lens was used to provide insight into the structural and cultural mechanisms that influence unsafe practice. In conclusion, recognition of, and response to unsafe practice was a fraught process for nurses. In addition, although reporting requirements exist, this process was assumed to be linear. However, this study showed that recognising and reporting unsafe practice was influenced by enablers and barriers that resulted in a highly complex process. The results provided comprehensive insight into the behaviours and cues that nurses recognised as indications of unsafe practice and how they responded to unsafe practice by their peers. When unsafe practice is recognised, organisations should have a response which focuses on excellent clinical practice. Organisations require policy and guidelines which are non-punitive and support practice improvement. There is scope for future research studies to extend this work and identify early interventions to decrease instances of unsafe practice.
- Subject
- unsafe practice; nurses; recognition; reporting; cues; intervening
- Identifier
- http://hdl.handle.net/1959.13/1422832
- Identifier
- uon:37880
- Rights
- Copyright 2021 Wendy Blair
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 13 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 446 KB | Adobe Acrobat PDF | View Details Download |