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Author |
Blackmore, L.A. |
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Title |
Triaging patients away from the emergency department: A review of the issues |
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Year |
2006 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Keywords |
Emergency nursing |
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Abstract  |
With the intention of decreasing emergency department demand, there has been a focus on determining those patients who do not require the services of the emergency department so they can be redirected away to an alternative health care provider or facility. Co-locating an after-hours primary health care facility near to the emergency department is a model under consideration in some district health boards. This model suggests that a substantial proportion of the patients currently managed in the emergency department can be assessed and managed in a general practice setting. It is envisaged that by redirecting the lower acuity patients away from the emergency department, overcrowding will be relieved. This is despite evidence demonstrating that low acuity patients are not the cause of emergency department overcrowding. Moreover, being treated at the emergency department is the only safety net for many people in the community who cannot afford alternative care. This research report discusses the literature regarding the practice of referring or redirecting patients away from the emergency department and the issues associated with this model. In doing this, it looks at the Australasian Triage Scale, the system used to ensure patients are seen in order of clinical urgency, because it has been suggested that this system could be used as a tool to refer patients away from the emergency department. The author concludes that even though some people could be seen by another health care provider, the triage system is not an appropriate tool for achieving this. While it is tempting to believe that patients in the lower triage categories are prime candidates for being referred away, there is evidence from hospital statistics that patients in these categories have a high number of hospital admissions and in-hospital death rates. Additionally, to complicate matters, there is no universal definition of what constitutes an 'appropriate' emergemcy department presentation and no consensus of opinion amongst health professionals in deciding patients' 'appropriateness'. For these reasons it is unethical to expect nurses who administer the triage system to use it for the purpose of referring people away from the emergency department. |
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Call Number |
NRSNZNO @ research @ |
Serial |
736 |
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Author |
Ward, C.R. |
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Title |
Children matter: What is important to the child living with a life-threatening illness |
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Miscellaneous |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Keywords |
Children; Nurse-patient relations; Nursing; Chronically ill |
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Abstract |
When a child lives with a life-threatening illness there is a range of emotions that affect the child, family and people close to the child. This study utilises a narrative approach to explore what the child puts emphasis on in what is important to them as they live with serious illness. The study incorporates the nurse as narrator with the 'narratives' of the children integrated into her reflections to gain a broader understanding. The focus is on listening intently to the spoken needs of children, their story and the meaning they make of their situation when they live with their illness. 'Children' in this study are between the ages of six years to 15 years. The aim of this research is to provide a clear understanding of the lived experience, which may illuminate the needs of the child and what is required throughout the time of illness; therefore informing health professionals of a culture of care that may support these needs. A broader understanding and deeper insight into the complexity of children living with life-threatening illnesses provides a basis for the development of sensitive, humanistic quality nursing care for both the child and his/her family, this then enhances the potential for best practice for children living with a life-threatening illness. |
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Call Number |
NRSNZNO @ research @ |
Serial |
577 |
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Author |
Stevenson, A.F. |
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Title |
Realities and rhetoric: general hospital nursing in New Zealand 1945 to 1960 |
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Year |
1997 |
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Abbreviated Journal |
Victoria University of Wellington Library, Welling |
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Abstract |
Up until the 1980s most of the historical writing about nursing and nurses in this country has been told from the points of view of past nursing leaders. The realities of day-to-day nursing in New Zealand general hospitals were relatively unknown.This thesis examines the experience of general hospital nursing between 1945 and 1960. The recollections of thirty-four nurses who nursed during this period have provided the key sources from which the major themes of this study have emerged. These themes, of dirty work, authoritarian control and discipline, and learning nursing are discussed within the context of an expanding hospital system and a shortage of nurses.The study demonstrates the vast differences between the recollections of nurses of the experience of nursing and the rather high-flown rhetoric of the nursing leadership.Changes to the amount of cleaning, the ;level of discipline and control, and ways in which learning nursing was organised were small and gradual and occurred in the late 1950s.Overall, though, nursing in general hospitals by 1960 ws almost unchanged from the 1930s.An ethos of selfless service, opposition to unionism, and Christian altruism was till dominant amongst the nursing leadership. Nurses in training still worked a six day week, were expected to stay on duty until the work was done, and were supervised closely in, on and off duty time |
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Call Number |
NRSNZNO @ research @ 162 |
Serial |
162 |
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Author |
O'Reilly, A.F. |
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Title |
Relinquishing personhood in dementia: Discordant discourses: A nurse's inquiry |
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Year |
2002 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Keywords |
Dementia; Nursing; Nurse-patient relations; Relationships |
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Abstract |
This thesis traces the journey of the author's inquiry into family members' experience of the relinquishment of the personhood of a loved one with a dementia; a journey in which she reports that her own prior understandings were significantly challenged. The study was prompted by her experience of working in the area of dementia care and hearing, in the course of the working day, comments such as 'there's nobody there' made in relation to someone suffering from severe dementia. Such comments appear to imply that the person of the dementia sufferer in some way is no longer present. They are comments which relate to the very nature of personhood. The study takes impetus from the fact that the ways in which nurses view the personhood of dementia sufferers has significant consequences for the ways in which they respond to dementia sufferers and their families. This thesis, which retells the stories of four family members who each have a loved one with a dementia illness, reveals that rather than there being a unified concept of personhood in dementia, and in spite of the fact that particular understandings of dementia and personhood dominate our cultural conversations, in their day to day lives these four family members managed and made sense of their experience through particular and different ways of looking at the impact dementia has on the personhood of dementia sufferers. Not all did, in fact, relinquish the personhood of their family member. In their lived lives, the four research participants had recourse, each in different ways, to multiple discourses of personhood. For some, in addition to loss, there was also unexpected gain. This finding necessitated and shaped further inquiry into discourse and the role of discourse in shaping, constraining and opening up possibilities for meaning, and into the two substantive areas of dementia and personhood. Nurses work closely alongside the family of dementia sufferers who are daily faced with the challenge of managing and making meaning of that situation. It is critically important that they are able to recognise, validate and support the variety of needs that family members have. Nurses, whose education is traditionally based on a biomedical framework, are nevertheless often required to mediate between different understandings. Not only do they need currency of knowledge in the rapidly changing biomedical field of dementia, but they need also an understanding of the role and the power of discursive constructions of both dementia and personhood. Such understanding will provide insight into alternate ways of understanding these concepts. However, although such understanding is critical for nurses working in this area, the author suggests that nursing literature has not brought these discussions to the fore. |
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Call Number |
NRSNZNO @ research @ 792 |
Serial |
776 |
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Author |
McClunie-Trust, P. |
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Title |
Body boundaries and discursive practices in life threatening illness: Narratives of the self |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Nurse-family relations; Nursing; Ethics |
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Abstract |
This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. |
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Call Number |
NRSNZNO @ research @ |
Serial |
791 |
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Author |
Boyle, S.D. |
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Title |
Nursing education in New Zealand: a case study of experiential learning |
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Year |
1994 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library & Welli |
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This thesis presents a study of a nursing 'practicum' from the perspectives of nursing students and staff 'buddies'. A grounded theory approach was used to interview six nursing students during their transition placement, the final practicum of their Diploma in Nursing programme. Five staff nurse buddies selected by the students were also interviewed. An informal, conversational interview was used and data was analysed from an experiential learning perspective.This study differs from others because it focuses on the clinical experience component of nursing education, 'practicum', and includess practitioners viewpoints. At present there is a re-evaluing of experience within nursing education with a new emphasis on practice-based learning. Experience-based learning is becoming increasingly acceptable within academia as a 'seamless' education system evolves.I identified three learning stages which students' experience during practicum – initiation, exploration and consolidation. The key stage for learning through experience was exploration. Learning during this stage was predominantly buddy-directed which contradicted the self-directed curriculum design. Students and staff nurses however agreed that communication between them during this stage enabled the development of 'competence'.The learning /teaching approach used by the students and staff nurses made it difficult for students to translate their 'all-round' competencies during practicum. It is argued that it is the useof such competencies during practicum which enable nursing students to become autonomous in the attitudinal and epistemological sense. The predominantly 'technical training' approach adopted was understood by students and staff nurses to be reinforced by 'silence' from tutors.Restructuring gives the opportunity for nursing to develop an ';investigative', enquiry-based approach in practice. There will increasingly be an emphasis on practice-based research as a result of the implementation of degree and post-graduate programmes in nursing. This study highlights some aspects of nursing education and it's relationship with practice which can assist the development of such an approach |
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Call Number |
NRSNZNO @ research @ 339 |
Serial |
339 |
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Author |
Rose, A. |
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Title |
Is case management an efficient and effective model of care for complex patients in an acute medical setting? |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Clinical decision making; Culture; Nursing; Quality assurance |
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Abstract |
This thesis looks at the prospect of developing and implementing case management as a model of care for complex patients in an acute medical setting. An extensive literature review was conducted to explore the concept of case management and to identify the role of the case manager, including the qualities and qualifications required for the position. Clinical pathways are a tool used in case management so these are also included in the literature review. As the author had been involved in the development of the first clinical pathway for Hutt Valley Health, this is used as an example to clarify how case management and clinical pathways can be used in conjunction. A discussion chapter examines the advantages and disadvantages of case management which shows that it can be an effective and efficient model of care through the development of clinical pathways. The ethical implications of case management are also considered. The thesis concludes with recommendations for the continued development of case management as a model of care to improve the quality of care for both patients and the organisation. During the course of the thesis, other areas that are worth further investigation have also been identified, such as the relevance of case management to different cultures. The thesis suggests that a proposal for case management for complex patients in the acute care setting is developed along with a job description for the role of the case manager. |
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Call Number |
NRSNZNO @ research @ |
Serial |
908 |
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Author |
Mitchell, D.F. |
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Title |
Is it possible to care for the “difficult” male? A study exploring the interface between gender issues, nursing practice and men's health |
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Year |
1999 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Issue |
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Pages |
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Keywords |
Male; Nurse-patient relations; Gender |
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Abstract |
This thesis is about caring for males, especially those males who could be considered “difficult” to care for through their use of behaviours such as silence, anger or defensive humour. This thesis is positioned in the view that these behaviours are often expressions of distress, which typically distance males from those who attempt to care for them. The author suggests that the word “distress” more accurately reflects the theme of the thesis, and it is used throughout the work. This thesis explores the interface between gender issues, nursing practice and caring for males. It is informed by a review of relevant literature and data gathered from a focus group of nine registered nurses. The analysis is framed by questions that are developed from a series of reflections on my personal and professional life. Critical social theory, with its emphases on dominant dialogue, power and emancipation is used to inform and guide this analysis. What is most obvious is the contrast between themes arising from the literature and those arising from the focus group. It appears that the literature, in the main, is critical of males in regard to concepts of masculinity, issues related to gender, and men's health. Males are portrayed as arbitrators of their own misfortune, as deliberately choosing a lifestyle that reflects poorly on their health, their self-expression, and communication with others. Concepts such as power and control over others, both at a societal and individual level, often feature. Conversely, the literature is noticeably lacking in regard to information about the health related experiences of males and about caring for males. In contrast, the participants of the focus group frame their discussion in the positive. For example, they suggest that males are interested in their health but require an environment that supports this expression of interest. They support this by identifying a range of behaviours they believe are effective in caring for males. The participants also suggest that it is the registered nurse rather than the male who manages issues to do with power and control. The thesis concludes that creating and sustaining an environment supportive of, and sensitive to the needs of males, is an activity that requires considerable thought, skill and experience. These areas are not adequately addressed in academic dialogue, research activity, or in the education of registered nurses. The thesis suggests that this situation is inconsistent with an ethic of care and that nursing should make a priority of broadening its research and knowledge base to better understand and care for males. |
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Call Number |
NRSNZNO @ research @ 503 |
Serial |
489 |
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Author |
Thompson, S.A. |
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Title |
Getting it right: An exploration of compulsive caregiving and helping profession syndrome |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Psychology; Nursing |
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Abstract |
This thesis is a theoretical exploration of the concepts of 'Compulsive caregiving' and 'helping profession syndrome' in relation to the choice of nursing as a career. These concepts are derived from Bowlby's attachment theory and psychodynamic psychotherapy. Both have evolved from psychoanalytic theory. The thesis explains Bowlby's development of compulsive caregiving in health professionals. The author notes that her life history and experience as a nurse educator and as a nurse practicing psychotherapy support this theoretical explanation. An argument is developed that the propensity towards compulsive caregiving is a strength in nurses. Nursing places high value on caring and many of the traits exhibited by compulsive caregivers are desirable in nurses. Nursing as a caring interpersonal process is explored with reference to the literature. However, nursing has been identified as a stressful occupation. Support strategies such as professional supervision and reflective practice are discussed. Thesis concludes with a suggestion for further research on compulsive caregiving and helping profession syndrome. |
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Call Number |
NRSNZNO @ research @ 813 |
Serial |
797 |
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Author |
McKergow, C.R.W. |
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Title |
Preparing to care in the 21st century: A personal search for the meaning of ontological competency through an embodied journey of the soul |
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Year |
2002 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing; Professional development; Breast cancer; Cancer |
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Abstract |
This thesis is a philosophical inquiry that reflects a personal search for the meaning of ontological competency undertaken by the author after developing breast cancer. The text weaves together in creative synthesis, a collection of academic and personal writing undertaken during an MA (Applied) in Nursing degree process. Using the work of Dowling Singe (1999), Watson (1999), and Wilber (1985, 1990, 1991 & 2000), the thesis seeks, through the use of reflective autobiographical inquiry (Johnstone 1999a), to explore the personal meaning-making activities engaged in during this time to throw light upon the nature of nurse / nursing being. Exploring developmental schemata drawn from personal experience and illuminated by theory, nurses and nursing are challenged to become more self-reflective and self-aware. To facilitate the personal and professional growth that underpins notions of ontological competency, various aids in the form of maps and models are provided to support a transformative journey into awareness. From this position of expanding consciousness, the nurse / nursing is encouraged to reach beyond current paradigms, metaparadigms, epistemologies, and restrictive philosophies and to yield to the evolutionary imperative that seeks to prepare for a 21st century clinical practice where caring / healing becomes embodied enactment from “the Ground of All Being”. |
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Call Number |
NRSNZNO @ research @ |
Serial |
774 |
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Author |
Little, S. |
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Title |
An exploration of vicarious traumatisation in emergency nurses |
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Year |
2002 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing; Occupational health and safety; Nursing research; Stress |
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Abstract |
This thesis explores the theoretical notions of suffering and caring within the nurse patient relationship in the context of emergency nursing. It includes a small pilot study that aimed to assess the feasibliity of a major research project, by describing the impact of vicarious traumatisation in emergency nurses, specifically in relation to their self capacities. This pilot study utilised a descriptive, correlational design. Data was collected by using the Inner Experience Questionnaire (IEQ) a twenty four-item questionnaire developed by Dr Pearlman (1995), and a profile sheet which identified demographic details. Twenty-seven emergency nurses participated in this pilot study. The IEQ was assessed for internal reliability by applying the Cronbachs alpha and utilising a focus group to gain insight into the usability and relevance of the questions. The internal reliability of the IEQ suggests that it may be an appropriate tool to measure disruption of self capacities in the population of emergency nurses. Although the results are limited, and conclusions cannot be drawn, findings suggest a correlation between the variables of age, experience, nursing qualifications and a history of personal trauma and the IEQ. There is evidence that emergency nurses are affected psychologically when caring for the victims of trauma in emergency departments and the IEQ has the potential as a tool to be integrated into future emergency nursing studies. A multidimensional methodological approach is recommended to capture the many contours of the complex phenomena of vicarious traumatisation and the emergency nurse. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1249 |
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Author |
McKerras, R. |
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Title |
Waiting in the emergency department – it doesn't have to take all day |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing |
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Abstract |
This thesis explores the nature of the emergency department environment as it continues to challenge emergency nurses to meet the health needs of an increasingly complex emergency department population. The emergency nurse is also facing conflict and challenge with regard to workplace safety and patient rights. The author suggests that, until recently, very little debate or consideration has been given to the moral dilemmas raised in the ability of emergency department staff to deliver timely and appropriate care in an overcrowded environment. She goes on to say that, in New Zealand, there is no national consistency with regard to the waiting crisis, no national guidelines and no national consensus putting the emergency nurse at risk. This thesis argues the need to acknowledge waiting times as a significant safety issue at a national level as increasing waiting times continue to impact on patient outcomes and nursing practice. It challenges current practice, in particular the role of the emergency nurse and the potential to legitimise expansion of the role to improve the patient experience of waiting in the emergency department. |
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Call Number |
NRSNZNO @ research @ |
Serial |
512 |
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Author |
Southwick, M. |
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Title |
Pacific women's stories of becoming a nurse in New Zealand: A radical hermeneutic reconstruction of marginality |
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Year |
2001 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Pacific peoples; New graduate nurses |
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Abstract |
This thesis examines Pacific women's experiences of becoming a nurse and their first year of practice post-registration, within the New Zealand context. The participants' stories of being students and beginning practitioners are inter-woven with the author's own reflections as a nurse and nurse educator who also claims a Pacific cultural heritage. To create the space in which the stories can be laid down, the thesis includes a description of the migration and settlement of Pacific peoples in Aotearoa/New Zealand. This description shows how Pacific people have been systematically stigmatised and locked into marginalised positions by mainstream dominant culture. The thesis deconstructs, what the author describes as, taken-for-granted and self perpetuating conceptualisations of marginality that currently underpin most theoretical explanations and proposes a reconstructed map of marginality. This deconstructed/reconstructed map of marginality is used as a template through which the experiences of the participants are filtered and interpreted. Radical Hermeneutics provides a philosophical underpinning for this project that has as one of its objectives the desire to resist reducing complexity to simplistic explanation and superficial solutions. The thesis challenges nursing to examine its role in reproducing the hegemonic power of dominant culture by applying unexamined cultural normative values that create binary boundaries between 'them' and 'us'. At the same time the thesis challenges Pacific people to move past hegemonically induced states of alienation and learn how to walk in multiple worlds with confidence and power. |
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Call Number |
NRSNZNO @ research @ |
Serial |
485 |
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Author |
Dearden, G. |
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Title |
When things go wrong: The experiences of mental health nurses who have had a patient die through suicide |
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Year |
2004 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Mental health; Psychiatric Nursing; Nurse-patient relations; Case studies; Suicide |
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Abstract |
This thesis discusses the findings of a research study, informed by the work of van Manen (1997b), which explored the lived experiences of five mental health nurses who have had a patient die through suicide. Narrative was used as a method in interviews to uncover the essence of their lived experiences. Five interwoven themes uncovered in each of the interviews were: impact, support, feelings, closure and paradox. All of the nurses interviewed experienced a wide range of feelings about their patient's suicides, ranging from shock to guilt, to anger and sadness, and described their patient's suicide as having a significant impact on them. Support received by the nurses following their patient's suicide was variable, and they were often in the difficult position of trying to offer support to the patient's family. Common to all of the nurses was the lack of closure following the suicide. Paradox was found to be the overall essence of the experience of the mental health nurses interviewed. Three main paradoxical themes or statements were identified that are in many respects a summary of all of the themes that emerged. These were: unavoidable – responsible; inevitable – unprepared; duty of care – respect for patient's decision to end their life. The author suggests that the ability of the nurses interviewed to accept and reconcile the paradoxical issues that arise in relation to patient suicide, and accept the lack of closure they experience, is a fundamental element in their ability to continue to work in the mental health setting, despite the significant impact their patient's suicide has had on them. Four recommendations are made based on the insights gained from this research. These are: that every mental health service should have a suicide response policy; that undergraduate nursing education includes the impact of patient suicide; the development of policies which promote dialogue about suicide within the community; and the need for further research in this topic. |
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Call Number |
NRSNZNO @ research @ |
Serial |
602 |
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Author |
Roberts, F. |
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Title |
The people the programme & the place: Nurses' perceptions of the Lakeland Health Professional Development Programme |
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Year |
1999 |
Publication |
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Abbreviated Journal |
NZNO Library, Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Careers in nursing; Professional development; Registered nurses |
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Abstract |
This thesis concerns the Professional Development Programme at Lakeland Health. In New Zealand, such programmes were introduced as a mechanism to openly recognise the clinical expertise of nurses. Clinical Career Pathways were introduced to nursing in North America in the 1970's at a time of nursing shortage. Prior to their inception, nurses wishing to develop their careers had to move to administration, management or education. The programmes recognised and rewarded expertise in practice. A qualitative, descriptive approach (using focus groups) was used with Registered Nurses to gather their perceptions of what helps nurses enroll in the Professional Development Programme. The ideas and insights of nine Registered Nurses were clustered around three main categories: The People (fear; being struck; motivation; feedback; peer support; ways of learning); the Programme (relevance; flexibility; Bachelor's Degrees; implementation; supporting information; fairness); the Place (time; regular and accessible; support from nurse leaders; management). These perceptions are discussed in more detail in the context of nursing at Lakeland Health and of Clinical Career Pathways in New Zealand. The findings are helpful for the evaluation and future development of the Professional Development at Lakeland Health. The research contributes to our understanding of what helps nurses enroll in a Clinical Career Pathway, and emphasises the importance of the People, the Programme and the Place. |
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Call Number |
NRSNZNO @ research @ 1150 |
Serial |
1135 |
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