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Palese A, Chiappinotto S, Bayram A, Sermeus W, Suhonen R, Papastavrou E. Exploring unfinished nursing care among nursing students: a discussion paper. BMC Nurs 2023; 22:272. [PMID: 37596561 PMCID: PMC10436392 DOI: 10.1186/s12912-023-01445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations. METHODS A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022. RESULTS In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities. CONCLUSION Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy.
| | | | - Aysun Bayram
- Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
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Kearns AJ. The principle of double effect and external whistleblowing in nursing. Nurs Outlook 2022; 70:807-819. [PMID: 36400577 DOI: 10.1016/j.outlook.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.
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Affiliation(s)
- Alan J Kearns
- School of Theology, Philosophy, and Music, Dublin City University, Dublin, Ireland.
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Wang D, Zhan C. Why Not Blow the Whistle on Health Care Insurance Fraud? Evidence from Jiangsu Province, China. Risk Manag Healthc Policy 2022; 15:1897-1915. [PMID: 36268183 PMCID: PMC9577100 DOI: 10.2147/rmhp.s379300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To identify the factors that influence whistleblowing behavior as it relates to health care insurance fraud in Jiangsu Province, China. Methods To construct a factor model and formulate research hypotheses using the Motivation–Opportunity–Ability framework. We designed a questionnaire containing 24 items and distributed it on-site to 2081 respondents in Jiangsu Province, China. Afterward, we applied structural equation modeling to validate the research hypotheses. Results Policy awareness negatively contributes to whistleblowing behavior, risk perception does not reduce the incentive to blow the whistle, and an inability to recognize fraud is another critical barrier to converting whistleblowing intentions into behavior. Conclusion Practices that are likely to promote citizen whistleblowing on insurance fraud may focus on the constraints identified by the comprehensive Motivation–Opportunity–Ability framework.
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Affiliation(s)
- Dandan Wang
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Changchun Zhan
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China,Correspondence: Changchun Zhan, Tel +86-15952808385, Email
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Jack K, Levett-Jones T, Ylonen A, Ion R, Pich J, Fulton R, Hamshire C. "Feel the fear and do it anyway" … nursing students' experiences of confronting poor practice. Nurse Educ Pract 2021; 56:103196. [PMID: 34534726 DOI: 10.1016/j.nepr.2021.103196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022]
Abstract
AIM The two aims of this study were, first, to explore nursing students' experiences and perspectives of reporting poor care and second, examine the process by which they raised concerns. BACKGROUND The nursing literature is replete with studies which explore nursing students' experiences of clinical placement. However only a small number explore students experiences of challenging poor care and how this is enacted in the practice setting. SETTING AND PARTICIPANTS Fourteen nursing students from undergraduate pre-registration nursing programs across three universities, two in the United Kingdom (UK) and one in Australia. DESIGN AND ANALYSIS This paper reports findings from narrative interviews about students' clinical experiences of reporting poor care. Data were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Emerging themes were identified, discussed and verified by the researchers. RESULTS Four montages from the narratives highlight the overarching themes: bullying, patient advocacy, lack of empathy and poor care. They demonstrate how, driven by an ethical imperative, students speak up when they witness poor care despite the difficulties of doing so: in some cases, the students in this study were prepared to continue speaking out even when initial concerns were dismissed. CONCLUSION Both practice and university teams have a responsibility to support students' development as ethical and courageous practitioners, able to recognize when care falls below an acceptable standard.
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Affiliation(s)
- Kirsten Jack
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester M15 6GX, UK.
| | | | | | - Robin Ion
- University of the West of Scotland, UK
| | | | | | - Claire Hamshire
- Faculty Head of Education, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, UK
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Fagan A, Lea J, Parker V. Student nurses' strategies when speaking up for patient safety: A qualitative study. Nurs Health Sci 2021; 23:447-455. [PMID: 33733584 DOI: 10.1111/nhs.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.
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Affiliation(s)
- Anthea Fagan
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Vicki Parker
- School of Health, University of New England, Armidale, New South Wales, Australia
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Koskinen S, Pajakoski E, Fuster P, Ingadottir B, Löyttyniemi E, Numminen O, Salminen L, Scott PA, Stubner J, Truš M, Leino-Kilpi H. Analysis of graduating nursing students' moral courage in six European countries. Nurs Ethics 2020; 28:481-497. [PMID: 33118442 PMCID: PMC8182296 DOI: 10.1177/0969733020956374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Moral courage is defined as courage to act according to one’s own ethical
values and principles even at the risk of negative consequences for the
individual. In a complex nursing practice, ethical considerations are
integral. Moral courage is needed throughout nurses’ career. Aim: To analyse graduating nursing students’ moral courage and the factors
associated with it in six European countries. Research design: A cross-sectional design, using a structured questionnaire, as part of a
larger international ProCompNurse study. In the questionnaire, moral courage
was assessed with a single question (visual analogue scale 0–100), the
questionnaire also covered several background variables. Participants and research context: The sample comprised graduating nursing students (n = 1796) from all
participating countries. To get a comprehensive view about graduating
nursing students’ moral courage, the views of nurse managers (n = 538) and
patients (n = 1327) from the same units in which the graduating nursing
students practised were also explored, with parallel questionnaires. Ethical considerations: Ethical approvals and research permissions were obtained according to
national standards in every country and all participants gave their informed
consent. Results: The mean of graduating nursing students’ self-assessed moral courage was 77.8
(standard deviation 17.0; on a 0–100 scale), with statistically significant
differences between countries. Higher moral courage was associated with many
factors, especially the level of professional competence. The managers
assessed the graduating nursing students’ moral courage lower (66.5;
standard deviation 18.4) and the patients slightly higher (80.6; standard
deviation 19.4) than the graduating nursing students themselves. Discussion and conclusions: In all countries, the graduating nursing students’ moral courage was assessed
as rather high, with differences between countries and populations. These
differences and associations between moral courage and ethics education
require further research.
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Affiliation(s)
| | | | - Pilar Fuster
- 88179International University of Catalonia, Spain
| | - Brynja Ingadottir
- 63541University of Iceland and Landspitali University Hospital, Iceland
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Brown P, Jones A, Davies J. Shall I tell my mentor? Exploring the mentor‐student relationship and its impact on students' raising concerns on clinical placement. J Clin Nurs 2020; 29:3298-3310. [DOI: 10.1111/jocn.15356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | - Aled Jones
- School of Healthcare Science Cardiff University Cardiff UK
| | - Jane Davies
- School of Healthcare Science Cardiff University Cardiff UK
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Gagnon M, Perron A. Whistleblowing: A concept analysis. Nurs Health Sci 2019; 22:381-389. [DOI: 10.1111/nhs.12667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Marilou Gagnon
- School of NursingUniversity of Victoria Victoria British Columbia Canada
| | - Amélie Perron
- School of NursingUniversity of Ottawa Ottawa Ontario Canada
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Milligan F, Wareing M, Preston-Shoot M, Pappas Y, Randhawa G, Bhandol J. "Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature". NURSE EDUCATION TODAY 2017; 57:29-39. [PMID: 28711721 DOI: 10.1016/j.nedt.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 05/11/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. OBJECTIVE To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. DATA SOURCES In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. REVIEW METHOD Sandelowski and Barroso's (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, radiography, dietitian, and music and art therapy. RESULTS Twenty three research studies were analysed. Most of the research relates to nursing students with physiotherapy being the next most studied group. Students often express a desire to report concerns, but factors such as the potential negative impact on assessment of their practice hinders reporting. There was a lack of evidence on how, when and to whom students should report. The most commonly used research approach found utilised vignettes asking students to anticipate how they would report. CONCLUSIONS Raising a concern with the quality of practice carries an emotional burden for the student as it may lead to sanctions from staff. Further research is required into the experiences of students to further understand the mechanisms that would enhance reporting and support them in the reporting process.
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Affiliation(s)
- Frank Milligan
- Patient Safety, University of Bedfordshire, United Kingdom.
| | - Mark Wareing
- Practice Learning, University of Bedfordshire, United Kingdom
| | | | - Yannis Pappas
- Health Services Research, University of Bedfordshire, United Kingdom
| | - Gurch Randhawa
- Diversity and Public Health, Institute of Health Research, University of Bedfordshire, United Kingdom
| | - Janine Bhandol
- Learning Resources, University of Bedfordshire, United Kingdom
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Pohjanoksa J, Stolt M, Suhonen R, Löyttyniemi E, Leino-Kilpi H. Whistle-blowing process in healthcare: From suspicion to action. Nurs Ethics 2017; 26:526-540. [DOI: 10.1177/0969733017705005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. Objective: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. Research design: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. Participants and research context: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. Ethical considerations: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation’s policies. Findings: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. Discussion and conclusion: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.
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Affiliation(s)
| | - Minna Stolt
- University of Turku, Finland; Turku University Hospital, Finland
| | - Riitta Suhonen
- University of Turku, Finland; Turku University Hospital, Finland; City of Turku, Welfare Division Administration, Finland
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Ion R, Smith K, Dickens G. Nursing and midwifery students' encounters with poor clinical practice: A systematic review. Nurse Educ Pract 2017; 23:67-75. [PMID: 28259633 DOI: 10.1016/j.nepr.2017.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 12/30/2022]
Abstract
The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.
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Fagan A, Parker V, Jackson D. A concept analysis of undergraduate nursing students speaking up for patient safety in the patient care environment. J Adv Nurs 2016; 72:2346-57. [DOI: 10.1111/jan.13028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Anthea Fagan
- School of Health; University of New England; Armidale NSW Australia
| | - Vicki Parker
- School of Health; University of New England; Armidale NSW Australia
- Hunter New England Area Health Service; Valentine NSW Australia
| | - Debra Jackson
- School of Health; University of New England; Armidale NSW Australia
- Oxford Brookes University and Oxford University Hospitals; UK
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Ion R, Smith K, Moir J, Nimmo S. Accounting for actions and omissions: a discourse analysis of student nurse accounts of responding to instances of poor care. J Adv Nurs 2016; 72:1054-64. [DOI: 10.1111/jan.12893] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
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Blair W, Kable A, Courtney-Pratt H, Doran E. Mixed method integrative review exploring nurses’ recognition and response to unsafe practice. J Adv Nurs 2015; 72:488-500. [DOI: 10.1111/jan.12855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Wendy Blair
- New Zealand Nurses Organisation; Palmerston North New Zealand
| | - Ashley Kable
- School of Nursing and Midwifery; University of Newcastle; New South Wales Australia
| | - Helen Courtney-Pratt
- School of Nursing and Midwifery; University of Newcastle; New South Wales Australia
- Senior Research Fellow Wicking Dementia Research and Education Centre; Faculty of Health; University of Tasmania; Hobart Tasmania Australia
| | - Evan Doran
- Centre for Clinical Epidemiology and Biostatistics; University of Newcastle; New South Wales Australia
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Sabatino L, Rocco G, Stievano A, Alvaro R. Perceptions of Italian student nurses of the concept of professional respect during their clinical practice learning experience. Nurse Educ Pract 2015; 15:314-20. [DOI: 10.1016/j.nepr.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 07/08/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
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Andrew S, Mansour M. Safeguarding in medication administration: understanding pre-registration nursing students' survey response to patient safety and peer reporting issues. J Nurs Manag 2013; 22:311-21. [DOI: 10.1111/jonm.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Sharon Andrew
- Professor of Nursing, Senior Lecturer; Faculty of Health, Social Care and Education; Rivermead Campus; Anglia Ruskin University; Chelmsford Essex UK
| | - Mansour Mansour
- Professor of Nursing, Senior Lecturer; Faculty of Health, Social Care and Education; Rivermead Campus; Anglia Ruskin University; Chelmsford Essex UK
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