| Records |
| Author |
Mearns, G. |
| Title |
Developing autonomous ownership: A grounded theory study of how registered nurses working in aged care are advancing their nursing practice |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal  |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nurse practitioners; Geriatric nursing; Older people; Registered nurses |
| Abstract |
The introduction of nurse practitioner registration into New Zealand in 2001 was heralded as a move that would open up a wealth of opportunities for registered nurses to extend their practice into more independent roles and to provide a client-centred health service. It was also seen as a way to retain experienced registered nurses in the clinical practice area by providing a credible clinical career pathway. If nurse practitioner's are to meet these expectations, then, the author suggests, it is important to understand the processes that encourage or discourage nurses from advancing their practice. One of the early scopes of practice to be introduced was nurse practitioner with an endorsement in aged care scope of practice. Grounded theory was the method used to generate an explanation of how registered nurses working in aged care were preparing for the introduction of nurse practitioner roles. An analysis of early data highlighted codes around registered nurses in aged care extending and advancing their practice rather than preparing specifically for the nurse practitioner role. The research question for this study was: 'How are registered nurses in aged care advancing their nursing practice?' Semi-structured interviews were used to collect data from ten experienced registered nurses working in aged care clinical practice settings ranging from secondary hospital facilities, to community settings and residential care villages. Dimensional analysis of the data eventually generated three major conceptual categories: 'ownership of nursing', 'extending practice', and 'moving out of a comfort zone'. Of these, 'ownership of nursing' was identified as the core construct that linked the other categories together. The substantive theory that explains how registered nurses in aged care advance their clinical practice is 'developing autonomous ownership'. Nurses who develop autonomous ownership of nursing are more likely than other nurses to move out of a current comfort zone and advance their practice into more independent roles that suit their autonomous ownership of nursing. This study identified important contextual factors and conditions that support the development of an autonomous ownership of nursing and that subsequently facilitate advancing nursing practice. These include creating supportive environments, organisational commitment to advanced nursing practice roles, visible nursing leadership, congruence between organisational and nursing philosophies, interdisciplinary collaboration and participating in postgraduate education. The author suggests that the significance of this study is that it generated a theory about the processes that encourage or discourage nurses from preparing for, and progressing into, advanced nursing practice roles such as nurse practitioner. |
| Call Number |
NRSNZNO @ research @ |
Serial |
585 |
| Permanent link to this record |
| |
|
| |
| Author |
Williams, P. |
| Title |
The experience of being new in the role of Charge Nurse |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nursing |
| Abstract |
|
| Call Number |
NRSNZNO @ research @ 608 |
Serial |
594 |
| Permanent link to this record |
| |
|
| |
| Author |
Hall, J. |
| Title |
Building trust to work with a grounded theory study of paediatric acute care nurses work |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nurse-family relations; Nurse-patient relations; Children; Paediatric nursing; Intensive care nursing |
| Abstract |
Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury. Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse “works with” the child to maintain and advance medical stability. Nursing interactions are an important part of “working with”, communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate. An effective working-relationship with a nurse and family is founded on trust. Grounded theory methods supported the process of exploring the social processes of “building trust” whilst “working with” families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to “work with” and support the re-establishment of the parenting role. The “stepping in and out” of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to “be with”, using chat to get to know each other, involving and supporting the family to parent a “different” child and reassuring and giving realistic hope to help the child and parents cope with their changed future. A substantive theory of the concept of “building trust to work with” has been developed using grounded theory methods. The theory has been conceptualised using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident. |
| Call Number |
NRSNZNO @ research @ |
Serial |
597 |
| Permanent link to this record |
| |
|
| |
| Author |
Best, G.A. |
| Title |
Being pruned: Student nurses experience of being shaped in clinical practice by lecturers |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Students; Nursing; Education |
| Abstract |
|
| Call Number |
NRSNZNO @ research @ |
Serial |
599 |
| Permanent link to this record |
| |
|
| |
| Author |
Johns, S. |
| Title |
Being constrained and enabled: A study of pre-registration nursing students ethical practice |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Ethics; Nursing; Students |
| Abstract |
This study uncovers the experience of being ethical from the perspective of pre-registration nursing students. Using the qualitative methodology of phenomenology, specifically that outlined by van Manen, it seeks to show how students act ethically within everyday practice. Providing nursing care is an ethically charged undertaking and despite ethics taking an increasingly important place in nursing education, the author suggests that few studies show the contextual nature of ethical practice from the perspective of students. This study aims to partly redress this situation. In this study the author has interpreted the experiences of twelve pre-registration students. Using seventeen stories shared by the student participants, the author's personal understandings and literature, the meaning of being ethical has been illuminated. Three themes emerged from the interpretation. These include 'keeping things 'nice'', 'being true to yourself' and 'being present'. This thesis asserts that the overarching theme within these themes is that of 'being constrained and enabled'. Being constrained shows the experiences of students as they live through the tensions of being and doing as they strive to be ethical. Being enabled shows the experience of self-determination. Finally the study maintains that the shaping of ethical practice for undergraduate students may be enhanced when their reality is positioned and valued within educational processes. |
| Call Number |
NRSNZNO @ research @ 614 |
Serial |
600 |
| Permanent link to this record |
| |
|
| |
| Author |
Grainger, J. |
| Title |
Mind shift: Creating change through narrative learning cycles: A qualitative interpretive study of clinical conversation as an appraisal process for sexual and reproductive health nurses |
Type |
|
| Year |
2007 |
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Sexual and reproductive health; Nursing; Professional development |
| Abstract |
This thesis explores the process of an annual appraisal strategy, 'clinical conversation', from the perspective of seven nurses who were assessed using this technique. The findings demonstrate that clinical conversation is a strategy which facilitates reflection, both as a solitary exercise and with others, to ensure that learning from experience is optimised. The research used a qualitative interpretive approach informed by the model of Grounded Theory espoused by Strauss and Corbin. All eight nurses who were assessed using the clinical conversation strategy were advanced practitioners working within the scope of sexual and reproductive health. Two of the actual appraisals were observed and seven of the nurses were interviewed within eight weeks of being assessed. The outcome of the clinical conversation was primarily one of learning; the acquisition of new insights into self as practitioner. The learning was facilitated through the process of narration; telling the story of clinical practice. Three distinct narrative cycles were identified, each an experiential learning episode. The experience of undertaking a variety of assessment activities created a narrative with self and triggered an internal reflective thinking process; the experience of working with a peer created an additional narrative, a mutual dialogue reflecting back on practice; the experience of sharing practice with an assessor created a further and final narrative, a learning conversation. Each narrative can be seen as a catalyst for change. Primarily, the nurses felt differently about themselves in practice, the way they saw themselves had shifted. Such a change can be described as an alteration in perspective. These alterations in perspective led all nurses to identify ways in which they would change their actual clinical practice. In this way the nurses attempted to align their espoused beliefs about practice with their actual practice. The author notes that the study shows that each nurse responded differently to each narrative learning cycle: for some the conversation with the assessor was more of a catalyst for change than for others. In this way clinical conversation may be flexible enough to respond to a variety of differing learning styles. Learning was person specific which is an imperative for the continued professional development of already highly skilled clinicians. The implication of the research is that whilst clinical conversation was designed as a tool for appraising clinical competence, its intrinsic value lies in supporting the professional development of nurses. |
| Call Number |
NRSNZNO @ research @ 833 |
Serial |
817 |
| Permanent link to this record |
| |
|
| |
| Author |
McArthur, J. |
| Title |
Discursive understanding of knowledge within advanced nursing practice roles: A co-operative inquiry in an acute health care organisation |
Type |
|
| Year |
|
Publication |
|
Abbreviated Journal |
Auckland University of Technology Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Advanced nursing practice; Organisational culture |
| Abstract |
|
| Call Number |
NRSNZNO @ research @ 1280 |
Serial |
1265 |
| Permanent link to this record |
| |
|
| |
| Author |
Jones, M. |
| Title |
The complexities of post operative pain management and a study of the effectiveness of continuous intravenous narcotic infusion pumps as a means of pain relief in the first 48 hours post operatively |
Type |
|
| Year |
1985 |
Publication |
|
Abbreviated Journal |
Author, Auckland Hospital, Auckland Institute of |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
The purpose of this paper was to observe the effectiveness of continuous intravenous narcotic infusions as a means of pain relief in the first 48 hours post operatively. 12 patients who had experienced major thoracic or abdominal surgery participated in the study. Pain was assessed at rest and on activity on visual analogues at 5 specific times daily for up to 48 hours post operatively. Data was also collected from a structured interview within the first 48 hours and a retrospective interview when the infusion was discontinued. Results indicated- 1. Very little correlation of changes in pain relief dose to the assessment of pain intensity. 2. Documentation and assessment was not always thoroughly completed. 3. Inadequate treatment of pain post operatively was evident especially on activity. It should be emphasised that pain management could be improved through a focus in interdisciplinary consultation, continuing in service education on pain management and accountability in procedure. |
| Call Number |
NRSNZNO @ research @ 102 |
Serial |
102 |
| Permanent link to this record |
| |
|
| |
| Author |
Margetts, M.; Cuthbertson, S.; Streat, S.J. |
| Title |
Bereavement follow-up – its impact on practice |
Type |
|
| Year |
1996 |
Publication |
|
Abbreviated Journal |
DCCM Auckland Hospital |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care |
| Call Number |
NRSNZNO @ research @ 200 |
Serial |
200 |
| Permanent link to this record |
| |
|
| |
| Author |
Margetts, M.; Cuthbertson, S.; Streat, S.J. |
| Title |
Bereavement follow-up service after fatal critical illness |
Type |
|
| Year |
1995 |
Publication |
|
Abbreviated Journal |
DCCM, Auckland Hospital |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
Fatal illness is often short. Communication between patient and family is impaired and how to best meet family needs is unclear. We began a follow-up service to determine current next-of-kins outcomes and remedy service deficiencies. A critical care nurse identified deaths from our data base and completed a structured telephone interview with the next-of-kin. There were 374 admissions from 1/1/95 – 17/5/95, 55 died. Next- of-kin of 52 patients (M29, age 19-88 median 52) were contactable 16-70 (median 33)days later. All (defacto/wives 18, husbands 9, mothers 9, daughters 8, others 8) consented to interview (5 -80, median 15 minutes). Forty-nine had resumed normal home activities and 23/25 workers had returned to work. Thirty-three still had disturbed sleep, three were taking hypnotics. Twenty-four had had contact with their general practitioner because of the death (six were prescribed sedatives or hypnotics). Nineteen had financial problems. Forty-seven described DCCM care positively, 35 specifically (nursing care and compassion 15, communication 8, flexible visitors policy8) but 13 had particular difficulties (communication 4 , waiting 2, facilities 4) and 4 serious non-DCCM issues. Forty-six considered themselves well informed and understood well the sequence of events. Forty-eight identified family and friends as primary support. Three requested information about another agency (counseling), 9 asked us to contact as further relative. A telephone bereavement service is well received by next-of-kin. Most families members resolve their early grief without external agencies but sleep and money are problems. We have improved our facilities and are addressing communication and cultural issues |
| Call Number |
NRSNZNO @ research @ 199 |
Serial |
199 |
| Permanent link to this record |
| |
|
| |
| Author |
Key, R.; Cuthbertson, S.; Streat, S.J. |
| Title |
Feasibility of a nurse-based critical care follow-up clinic |
Type |
|
| Year |
1994 |
Publication |
|
Abbreviated Journal |
DCCM, Auckland Hospital Private Bag 92024 Aucklan |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
We are about to implement a nurse-based critical care follow-up service and used a follow-up study of tracheostomy to determine the feasibility of such a service. Nine to 27 months median 14 after intensive care admission we attempted to follow-up 116 of our most severely ill survivors. Twenty six could not be found, 11 declined follow-up. A questionnaire, interview and limited examination were used to determine health status. Ten patients unable to come to a clinic were seen at home. Interview time varied between patients but 79 patients took 100 nurse-hours. Ninety percent of patients co-operated with respiratory function testing. Pulse oximetry identified one with severe chronic respiratory failure. In this highly selected group of patients with on going problems (perceived poor health, dependency, disability, changes in appearance, deterioration in personal relationships, poor sleep, pain, altered diet, unaddressed chronic health problems, poor access to health services, and continuing prescription medication) were common, and addressed to some extent by appropriate referral. Approximately 20% of patients reported improvement in their health and personal relationships after critical illness and half of the smokers had given up. Factors contributing to follow-up difficulty included distance, delay in initial contact, change of address (255 of this group), disability and poverty. A nurse-run critical care follow-up clinic is feasible, time consuming but productive. A register of current addresses and phone numbers is recommended. The optimal time for follow-up will vary with patients conditions but early follow-up with protocol- based lines of referral is recommended to reduce persistent health problems |
| Call Number |
NRSNZNO @ research @ 205 |
Serial |
205 |
| Permanent link to this record |
| |
|
| |
| Author |
Pearce, L.; Kirkham, S.; Cuthbertson, S. |
| Title |
Quality of follow-up for self-poisoning patients after discharge from intensive care: 1996, one year later |
Type |
|
| Year |
1996 |
Publication |
|
Abbreviated Journal |
DCCM, Auckland Hospital, P.O.Box 92024, Auckland |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care. |
| Call Number |
NRSNZNO @ research @ 207 |
Serial |
207 |
| Permanent link to this record |
| |
|
| |
| Author |
Pearce, L.; Cuthbertson, S.; Streat, S.J.; Hay, D. |
| Title |
Dental hygiene in the critically ill: a randomised controlled trial of three methods |
Type |
|
| Year |
1996 |
Publication |
|
Abbreviated Journal |
DCCM, Auckland Hospital, Private Bag 92024, Auck |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
Introduction Critically ill patients cannot clean their own teeth. A variety of methods are used but as the best method is unknown we performed a prospective randomised double-blind controlled trial of three methods.Method Of 359 consecutive admissions to the Department of Critical Care Medicine between 31/01/97 and 25/05/97, 222 were excluded (62 edentulous, 6 unexaminable, 142 transferred alive and 12 dead or dying at 24 hours). The remaining 137 patients had quantitative (picture-linked, ordinal score) assessment of caries, peridontal status and plaque (in 12 segments of teeth) before randomisation (to the use of either toothbrush, jumbo swab or sonic toothbrush) by pre-assigned sealed envelopes. All teeth were cleaned (prescribed four hourly) with 0.2% chlorhexidine solution. Daily plaque scores were obtained (by an assessor (SC) blind to treatment allocation) until withdrawal, death or transfer.Results Toothbrush Jumboswab SonicPatients assigned 50 48 39Withdrawn within 24hrs. 9 3 5Patients remaining 41 45 34Percentage of teeth segments thatare pristine: pre treatment 45 50 51 after 2 days 74 57 90 F(2.63) = 5.00 p = 0.0097 More withdrawals for patient noncompliance after randomisation occurred in the sonic group (5/34 versus 3/86). Conclusion. By the second day the sonic toothbrush was the most effective in plaque removal with the toothbrush the next most effective method |
| Call Number |
NRSNZNO @ research @ 203 |
Serial |
203 |
| Permanent link to this record |
| |
|
| |
| Author |
McManus, L.M.; Cuthbertson, S.; Streat, S.J. |
| Title |
When the lights went out in Auckland |
Type |
|
| Year |
1998 |
Publication |
|
Abbreviated Journal |
DCCM, Private Bag 92024 Auckland |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
As the clinical consequences of power failure in intensive care are seldom documented we reviewed the effects of a power failure on patient care, outcomes and the adequacy of our disaster plan. We reviewed clinical records of all ten patients in our department during a 20-minute total hospital power failure, determined the impact of the failure on the therapies being given, and the costs of failed equipment. We assessed the departments disaster plan and identified the causes of the power failure.Nine patients were intubated; six ventilated (one receiving nitric oxide) and three receiving continuous positive airway pressure. Two patients were ventilated by Servo 300,? which continued on batteries, the other four patients were ventilated manually. Six patients were receiving nine inotrope infusions through IMED Gemini,? (battery life 30 minutes). One patient was receiving high volume ultrafiltration using a Gambro? haemodialysis system, which failed. Blood flow to prevent clotting was maintained by turning the roller pump manually. All networked monitoring (SpaceLabs?) failed and three haemodynamically unstable patients were monitored by transport monitors (SpaceLabs Scout?). No patient suffered any ill effect. Failed electronic circuits cost $NZ11,724. The disaster plan was implemented and functioned well. The aged cables supplying Auckland Central failed during an El Nino summer. The hospital generators, supplying power to the city grid, failed to switch over to the hospital. During power failure infusion pumps should be only for inotropes. We now have external 12-volt battery backup. With good pre-planning, safe intensive care continued during a short power failure |
| Call Number |
NRSNZNO @ research @ 206 |
Serial |
206 |
| Permanent link to this record |
| |
|
| |
| Author |
Key, R.; Habashi, S.; Baber, C.; Cuthbertson, S.; Streat, S.J. |
| Title |
Long-term follow-up after Bjork flap tracheostomy |
Type |
|
| Year |
1994 |
Publication |
|
Abbreviated Journal |
DCCM, Private Bag 92024, Auckland |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
|
| Abstract |
Because of concern about long-term complications of bjork flap tracheostomy we followed-up 136 intensive care patients who had Bjork flap tracheotomy in 1992 a median of 117 (range 5-402) hours after intubation. Twenty died in hospital, none as a result of tracheostomy. Twenty- six patients were lost to follow-up and eleven declined. The remaining 79 had measures of health status, a quality of life questionnaire, respiratory function testing and physical examination of the neck and upper airway 9-27 months (median 14) later. Various health status measures deteriorated in 9 to 51 of 77 patients. Forty-two of 77 patients were taking prescription medication and 15/32 smokers had stopped smoking. FEV1, FVC and FEV1/FVC were significantly reduced from predicted normal (n=70, 2.8+ 1.1 vs 3.2 +0.9 p<.0001, 3.7 + 1.3 vs 4.0 + 1.0 p<.0001, 76 +11vs 79 +3 p= 0.035 respectively). Pulse oximetry was normal (>92%) in 73/74 patients tested. The median horizontal scar dimension was 45mm (range 20 to 75 mm). Nine had a median vertical scar dimension 15mm (range 8 to 25mm). Nineteen scars were hypertrophic, 56 were tethered. Two patients had already undergone tracheal scar revision at follow-up and further 13 accepted scar revision. Ten patients had abnormal voice examination, four abnormal cough, two stridor, three vocal cord lesions, three tracheal polyps and fourteen asymptomatic tracheal narrowing from 10-60% (median 25%) of the tracheal luminal diameter. Patients surviving critical illness with bjork flap tracheostomy have reduced quality of life and respiratory function and poor cosmetic result but a low incidence of important airway problems |
| Call Number |
NRSNZNO @ research @ 201 |
Serial |
201 |
| Permanent link to this record |
