Failure to rescue : a descriptive study of the experience of nurses in the intervention for patients at risk in the acute ward setting
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The research represented in this thesis describes the experience of nurses in the intervention for patients at risk in the acute ward setting. Specifically, the research focusses on ‘failure to rescue’ as a concept which can, and as this research demonstrates, does, result in adverse patient outcomes. It identifies, describes and analyses four distinct elements of this type of failure in the clinical setting: 1) failure to recognise the level of risk to the patient; 2) failure to respond to the patient’s level of risk; 3) failure to elevate patient risk to ensure an appropriate response; and 4) failure to challenge a perceived risk to patient safety. Through the use of patient stories, which describe the failure of the health care system and nursing staff to consistently and effectively intervene for patients at risk, the experience of nurses is analysed and compared to images of nurses present in the literature. These images are: the nurse as the ‘ministering angel’; the ‘domestic worker’; the ‘doctor’s handmaiden’; the ‘subordinate professional’; and finally the ‘autonomous professional’. The nurses in this research were viewed in these images by the organisation, the doctors and the nurses themselves. These views, and the reality they create, contribute to the inability of nurses to effectively intervene for patients at risk and pose a considerable threat to patient safety. The information gathered in this research describes the nurses’ actions, the nurses’ beliefs and the dissonance between the nurses’ actions and beliefs in relation to the intervention for patients at risk. This research makes it apparent that nurses play a vital and important role in ensuring patient safety through the intervention for patients at risk, but at times this role is neither recognised nor understood by both the health care system and the nurses themselves. The research argues that it is this lack of understanding and recognition which presents significant barriers for nurses to intervene consistently and effectively for patients at risk.
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