title: Accounting for actions and omissions: a discourse analysis of student nurse accounts of responding to instances of poor care.
abstract: OBJECTIVE
  To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators.
  
  
  BACKGROUND
  Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety.
  
  
  METHODS
  Semistructured interviews were conducted with 13 undergraduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement.
  
  
  METHODS
  Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall's version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice.
  
  
  RESULTS
  Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless.
  
  
  CONCLUSIONS
  This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns.
authors.affiliation: Abertay University, Dundee, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Ion
authors.affiliation: Abertay University, Dundee, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Smith
authors.affiliation: Abertay University, Dundee, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Moir
authors.affiliation: Abertay University, Dundee, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Nimmo
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011787:Quality of Health Care / Q000941:ethics*; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D035642:Whistleblowing / Q000523:psychology*; D055815:Young Adult
keywords: concerns; neglect; nurse; poor practice; reporting; student; whistleblowing