Navigating institutional complexity: The production of risk culture in the financial sector

Earlier versions of this paper were presented at the EGOS 2014 Colloquium, at research seminars at Copenhagen Business School and HEC Lausanne, and, under the title ‘Searching for Risk Culture’, as a keynote address at the SAMS/JMS annual conference on Managing Complexity Within and Across Organizational Boundaries at Cambridge University, March 2014. The authors are grateful for the helpful comments of Mats Alvesson, Roger Friedland, Matthew Hall, Silvia Jordan, Steve Maguire and Iain Munro, as well as the editors of the special issue of JMS on Managing Complexity. The authors gratefully acknowledge the financial support of the Economic and Social Research Council (ESRC), the Chartered Insurance Institute (CII), the Chartered Institute of Management Accountants (CIMA) and the Lighthill Risk Network

The Experience of Younger Adults Following Myocardial Infarction.

The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients

Enhancing the quality of CPR performed by laypeople

Introduction The prognosis of survival for a person suffering from cardiac arrest increases when a layperson performs cardiopulmonary resuscitation (CPR) on-site. In Sweden, providing CPR training to people working in public places is considered a social benefit. Objective The aim of this study was to investigate the effect of a 3-hour CPR intervention for electricians. Methods Data were collected through an intervention by means of simulation and consisted of a pre- and post-assessment of the participants’ CPR performance. Results The results show a statistically significant improvement in ventilation (41%) and quality of compression (36%). Conclusion With short rehearsal training, the layperson can significantly improve the quality of CPR given. In a situation of cardiac arrest, this can be crucial for the patient’s survival and continued quality of life

Registered nurses’ descriptions of caring : a phenomenographic interview study

Background: Nursing has come a long way since the days of Florence Nightingale and even though no consensus exists it would seem reasonable to assume that caring still remains the inner core, the essence of nursing. In the light of the societal, contextual and political changes that have taken place during the 21st century, it is important to explore whether these might have influenced the essence of nursing. The aim of this study was to describe registered nurses’ conceptions of caring. Methods: A qualitative design with a phenomenographic approach was used. The interviews with twenty-one nurses took place between March and May 2013 and the transcripts were analysed inspired by Marton and Booth’s description of phenomenography. Results: The analysis mirrored four qualitatively different ways of understanding caring from the nurses’ perspective: caring as person-centredness, caring as safeguarding the patient’s best interests, caring as nursing interventions and caring as contextually intertwined. Conclusion: The most comprehensive feature of the nurses’ collective understanding of caring was their recognition and acknowledgment of the person behind the patient, i.e. person-centredness. However, caring was described as being part of an intricate interplay in the care context, which has impacted on all the described conceptions of caring. Greater emphasis on the care context, i.e. the environment in which caring takes place, are warranted as this could mitigate the possibility that essential care is left unaddressed, thus contributing to better quality of care and safer patient care

Standing alone when life takes an unexpected turn: being a midlife next of kin of a relative who has suffered a myocardial infarction.

BACKGROUND: Suffering a myocardial infarction (MI) is a life-threatening event that impacts not only on the individual concerned but also on the next of kin. However, there seems to be a paucity of naturalistic inquiries that focus specifically on midlife next of kin and their experience of being close to a relative who has suffered an MI. This study aims to elucidate the experience of being a midlife next of kin of a relative who has suffered a myocardial infarction. METHOD: Nine women and four men in midlife participated in the focused interviews, which were conducted and analysed during 2010/2011 using Lindseths and Norbergs' description of the phenomenological hermeneutical method. FINDINGS: Four themes - Solely responsible, Lurking unease, Left out of the picture and Life on hold - formed the basis of the core theme Standing alone when life takes an unexpected turn. The core theme was interpreted as a central phenomenon encompassing the experience of being solely responsible for the well-being of their relative and the family, thus putting their own life on hold. The core theme also reflected the next of kin's experience of being left out of the picture when it came to the relative's care before and after the MI. CONCLUSION: The next of kin's negative feelings of standing alone were further intensified by their experience of being left out of the picture by the healthcare professionals concerning their relative's care. As a cardiac nurse, it would seem essential to have knowledge about the experiences of next of kin in connection with a relative's MI event. Such knowledge can facilitate the planning and organisation of nursing care and at the same time address the next of kin's role in the recovery and rehabilitation process

Conceptions of caring among a group of coronary care nurses

Background: During the last decade fundamental changes have taken place at coronary care units (CCUs) with regard to medical treatment and advanced technology in order to improve care for patients with coronary heart disease. In the past, caring in a coronary care context was described in qualitative studies mostly from the patients’ point of view. Coronary care nurses (CCNs) are considered to play a crucial role in this care although research into nurses’ conceptions of caring in this area is still scarce. Extended knowledge from the CCNs’ perspective could be of help in developing and implementing new, nurse-led interventions in a coronary care context. Aim: This study aims to describe the conceptions of caring among a group of coronary care nurses. Methods: This is an interview study. Phenomenographic interviews with open-ended questions were conducted with 21 purposefully sampled CCNs from CCUs at two different county hospitals. The audio-taped interviews took place between March and May 2013 and the data consist of 365 double-spaced pages. The age of the CCNs ranged from 23 to 63 years, the length of experience working as a registered nurse ranged from 1 to 42 years and experience as a CCN ranged from 0.5 to 27 years. A phenomenographic analysis according to the steps described by åkerlind was used. The interviews were read several times in order to gain an overall impression of the data. The central elements of the CCNs’ responses that focus on ’what’ and ’how’ were identified, condensed and summarised as a preliminary means of understanding a phenomenon. Similar responses were carefully grouped or classified and a comparison of the categories was made in order to establish the borders between them. The descriptive categories were created on the basis of similarities and differences. An iterative process was used throughout the data analysis to check interpretation against the interviews that had been transcribed verbatim and the description categories. The description categories were used to develop an ‘outcome space’ that described the wholeness of the findings. Results: The analysis is ongoing. At the beginning of 2014 we expect to present preliminary results and answer questions about qualitatively different conceptions of caring found among a group of CCNs working in CCUs and how the different conceptions of these individuals can be understood

Adverse events in nursing: a retrospective study of reports of patient and relative experiences.

Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them

Factors contributing to serious adverse events in nursing homes

AIMS AND OBJECTIVES: The aim of this study was to identify the most common serious adverse events that occurred in nursing homes and their most frequent contributing factors to contribute to improvement of safe nursing care. BACKGROUND: There is a need to improve safe nursing care in nursing homes. Residents are often frail and vulnerable with extensive needs for nursing care. A relatively minor adverse event in nursing care can cause serious injury that could have been preventable. DESIGN: This was a retrospective study, with a total sample of data regarding adverse events (n=173) in nursing homes, concerning nursing care reported by health care providers in Sweden to the Health and Social Care Inspectorate. The reports were analysed with content analysis and the frequencies of the adverse events, and their contributing factors, were described with descriptive statistics. RESULTS: Medication errors, falls, delayed or inappropriate intervention and missed nursing care caused the vast majority (89%) of the serious adverse events. A total of 693 possible contributing factors were identified. The most common contributing factors were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. CONCLUSIONS: The contributing factors frequently interacted yet they varied between different groups of serious adverse events. The resident's safety depends on the availability of staff's competence as well as adequate documentation about the resident's condition. Lack of competence was underestimated by health care providers. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses and assistant nurses need to have awareness of contributing factors to adverse events in nursing care. A holistic approach to improve patient safety in nursing homes requires competence of the staff, safe environments as well as resident's and relative's participation. This article is protected by copyright. All rights reserved

Health risks and occupational exposure to volatile anaesthetics : a review with a systematic approach

Aims and objectives. To provide practicing nurse anaesthetists with evidence based knowledge as to whether they are at risk handling volatile anaesthetics by answering the question: What are the health risks threatening health care personnel occupationally exposed to volatile anaesthetics? Background.  The interpretations of results from specific scientific studies vary and preliminary research results indicate that occupational exposure to volatile anaesthetics affects the health of operating room personnel. Design.  Review of scientific literature with a systematic approach. Method.  The review included a systematic search in three major databases, a screening process of abstracts/articles followed by a quality assessment of the included studies. The screening process and the quality assessment were done independently by the six reviewers and followed specific protocols. Results.  A systematic search of The Cochrane Library, MedLine and CINAHL resulted in a screening of 413 abstracts of which 31 articles were assessed for quality, all done independently by the reviewers. Finally, the reviewers agreed upon how to interpret the results of the assessed articles. Conclusions.  The 31 articles assessed covered areas such as genotoxic effects, neurobehavioural effects, immunology, and general health effects. In the scientific literature reviewed there is no evidence of occupational exposure to volatile anaesthetics either being associated with health risks or being harmless. Studies indicating a potential health risk are all investigating circumstances ignorant of modern environmental regulations and/or with no scavenging equipment. Relevance to clinical practice.  Although no answer has been given, this review illuminates the methodological difficulties encountered in designing studies. The result of this review further stresses the need for scientific knowledge in this area and enhances the extensive use of scavenging equipment