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Howie, L. (2008). Rural society and culture. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 3-18 ). [Dunedin]: Rural Health Opportunities.
Abstract: The author takes a multidisciplinary approach to examine how the location and concept rural is defined and provides a critique of the disparate definitions available. Definitions encompass different disciplines such as sociology and anthropology, and there are national distinctions based on historical factors. The chapter also investigates the way researchers speak about rural people, particularly as the human aspect of health is a primary concern to nursing. The focus is on the socio-cultural, occupational, ecological, and health aspects of rurality. The Rural Framework Wheel is introduced, which is a method to categorise rural contextual definitions. Rurality is presented as a variable and evolving concept that provides particular challenges to nursing practice.
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Roberts, C. (2007). The influence of nursing culture on family visiting in adult intensive care units. Ph.D. thesis, , .
Abstract: This dissertation considers the implications of the relationship between nurses and the patient's family, when family members visit intensive care units (ICUs) following the acute admission of a relative there. In particular it explores the issues of power and control, nurses might have in this setting, the culture that supports that, and the implications this has for practice in the New Zealand context. A comprehensive literature review on the perspective of nurses in relation to relatives visiting adult intensive care units was conducted. The author concludes that nurses modify policies related to visiting access for family members to suit themselves, and the needs of their patient. Nurses use a variety of tactics to maintain a position of power and control by looking out for themselves first, their patient second, and relatives third. The need of the patient and their families is not well understood by nurses, and nurses feel they have inadequate skills to cope with the needs and stresses of visiting relatives. The author suggests that for nurses to provide family focused care in ICU they must develop a therapeutic relationship with all concerned. ICU nursing culture affects nurses ability to focus on caring for their patients and their families. Nurses in ICU appear to need to maintain power and control over their environment but further research is needed to identify the current situation in New Zealand ICUs.
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Morton, J., Williams, Y., & Philpott, M. (2006). New Zealand's Christchurch Hospital at night: An audit of medical activity from 2230 to 0800 hours. New Zealand Medical Journal, 119(1231).
Abstract: The authors conduct an audit of medical activity at Christchurch Hospital, a 650 bed tertiary centre, between 2230 and 0800 hours. They measured the volumes of tasks requiring completion overnight and identified the competencies required for this as well as the level of teamwork that existed. They found several organisational areas of concern, that indicate new approaches are required to staff the “hospital at night,” and an Out of Hours Multidisciplinary Team is recommended. Specific issues included the lack of teamwork from the Resident Medical Officers (RMOs), with some overextended while others were inactive. House officer tasks were largely generic rather than specialty specific; there was no formal handover from the afternoon or day shifts and the level of hospital medical staffing did not reflect the activity levels over the time period studied. The researchers also recommend an urgent review of the beep policy. A third of the admissions were to General Medicine, and basic medical activities (including admitting, reviewing, and prescribing drugs and fluids) for patients admitted under all specialties represented the majority of the night workload. Medical registrars had reduced some of the traditional multiple clerking by admitting patients themselves.
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Wilkinson, J. A., & Huntington, A. D. (2004). The personal safety of district nurses: A critical analysis. Nursing Praxis in New Zealand, 20(3), 31–44.
Abstract: A workplace safety study of district nurses in New Zealand was conducted to explore personal safety experiences. A qualitative methodology informed by Critical Social Theory was employed. This paper details the findings and implications derived from data collected from six district nurses in two urban New Zealand health services who recalled incidents in which they felt their personal safety was compromised. Data were collected through individual interviews and a focus group discussion with the participants. Data analysis revealed two-fold risks to nurse safety; these were associated with client behaviour as well as risks embedded in the organisational structure. The findings suggest a number of practical issues involving basic security measures require urgent attention. The complex power relationships that shape the experience of nursing in a community impinged on the ability of the nurses in this study to confidently and safely fulfil their role. An organisational commitment to a culture of safety would help address the powerlessness experienced by district nurses.
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McBride-Henry, K., & Foureur, M. (2007). A secondary care nursing perspective on medication administration safety. Journal of Advanced Nursing, 60(1), 58–66.
Abstract: This paper reports on a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, or undermine, safe practice during this process. Data were collected in 2005 using three focus groups of nurses that formed part of a larger study examining organisational safety and medication administration from a nursing perspective. A narrative approach was employed to analyse the transcripts. Participants had good understandings of organisational culture in relation to medication safety and recognised the importance of effective multi-disciplinary teams in maintaining a safe environment for patients. Despite this, they acknowledged that not all systems work well, and offered a variety of ways to improve current medication practices. These findings highlight the meaningful contribution nurses can make to patient safety and emphasise the importance of including the nursing voice in any quality improvement initiatives.
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McBride-Henry, K., & Foureur, M. (2006). Organisational culture, medication administration and the role of nurses. Practice Development in Health Care, 5(2), 208–222.
Abstract: This research study was designed to identify ways of enhancing patient safety during the administration of medications within the New Zealand context. The researchers employed a multi-method approach that included a survey using the Safety Climate Survey tool, focus groups and three clinical practice development groups. The authors conclude that the outcomes of this study indicate that practice development initiatives, such as the ones outlined in this project, can have a positive effect on nurses' perceptions of organisational safety, which in turn has been demonstrated to have a positive impact on patient safety.
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Crowe, M. (2006). Psychiatric diagnosis: Some implications for mental health nursing care. Journal of Advanced Nursing, 53(1), 125–131.
Abstract: This article explores some of the functions of psychiatric diagnosis and the implications this has for mental health nursing care. It critiques the psychiatric diagnosis as a categorisation process that maintains oppressive power relations within society, by establishing and enforcing normality through gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is used to illustrate some of the inherent biases in the diagnostic process. The author argues that mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. To create a true patient-centred partnership in mental health nursing, the nursing focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. NB this is a reprint of article first published in Journal of Advanced Nursing, 2000 Mar; 31(3), 583-9.
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Flynn, L., Carryer, J. B., & Budge, C. (2005). Organisational attributes valued by hospital, home care, and district nurses in the United States and New Zealand. Journal of Nursing Scholarship, 37(1), 67–72.
Abstract: The aim of this study was to determine whether hospital-based, home care, and district nurses identify a core set of organisational attributes in the nursing work environment that they value as important to the support of professional practice. Survey data, collected in 2002 2003 from 403 home care nurses in the United States and 320 district nurses in New Zealand, were pooled with an existing data set of 669 hospital-based nurses to conduct this descriptive, nonexperimental study. The importance of organisational attributes in the nursing work environment was measured using the Nursing Work Index-Revised (NWI-R). The authors found that at least 80% of hospital-based, home care, and district nurses either agreed or strongly agreed that 47 of the 49 items comprising the NWI-R represented organisational attributes they considered important to the support of their professional nursing practice. Mean importance scores among home care nurses, however, were significantly lower than were those of the other two groups. The authors conclude that the overall, hospital-based, home care, and district nurses had a high level of agreement regarding the importance of organisational traits to the support of their professional practice. The intensity of the attributes' importance was less among home care nurses. Further research is needed to determine whether this set of organisational traits, measured using the NWI-R, is associated with positive nurse and patient outcomes in home care and district nursing practice, as has been shown in acute care settings.
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Wepa, D. (2003). An exploration of the experiences of cultural safety educators in New Zealand: An action research approach. Journal of Transcultural Nursing, 14(4), 339–348.
Abstract: This research is a study of the experiences of four cultural safety educators in nursing education in Aotearoa, New Zealand. Action research methods assisted the participants to implement change in their practice and gain positive personal involvement in the study. Reflective diaries provided the major tool in this process as participants were able to achieve at least one action research cycle by identifying issues, planning action, observing the action, and reflecting. The findings of the research revealed that the participants not only coped with everyday stressors of teaching but were also required to formulate knowledge for cultural safety. For the Maori participants, their stress was confounded with recruiting and retaining Maori students and macro issues such as commitment to their iwi (tribe). Lack of support to teach cultural safety was identified to be a key theme for all participants. An analysis of this theme revealed that many issues were organisational in nature and out of their control. Action research provided a change strategy for participants to have a sense of control of issues within their practice. Recommendations include the following: support for cultural safety educators to have a dialogue on a regular basis, the introduction of nurse educator programmes, paid leave provisions for educators to conduct and publish research so that a body of knowledge can be developed, and that Maori cultural safety educators be recognised for their professional and cultural strengths so that they do not fall victim to burnout.
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Rose, A. (2000). Is case management an efficient and effective model of care for complex patients in an acute medical setting? Ph.D. thesis, , .
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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Simon, V. N. (2006). Characterising Maori nursing practice. Contemporary Nurse, 22(2), 203–213.
Abstract: This paper summarises research which addresses the question What might constitute Maori nursing practice? The research design adopted was influenced by kaupapa Maori methodology and used a semi-structured, qualitative, in-depth interview process. It was found that by understanding the current experiences of Maori registered nurses, their reflections on their preparation for practice, and their current practice, it is possible to identify the present and future training and practice needs of Maori nurses. Maori nursing practice can be characterised as having five features: the promotion of cultural affirmation including cultural awareness and identity; the support of, and access to Maori networks; the adoption of Maori models of health; the enabling of visibility and pro-activity as Maori nurses; and, the validation of Maori nurses as effective health professionals. Three recommendations for promoting Maori nursing practice are made in relation to staff in the workplace and in nurse education programmes: all nursing staff need to be alert to: 1. the impact of western scientific models on Maori healthcare; 2. the (often passive) non-acceptance of Maori within mainstream institutions; and iii) the benefits of valuing indigenous nursing programmes.
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Horsburgh, M., Perkins, R., Coyle, B., & Degeling, P. (2006). The professional subcultures of students entering medicine, nursing and pharmacy programmes. Journal of Interprofessional Care, 20(4), 425–431.
Abstract: This study sought to determine the attitudes, beliefs and values towards clinical work organisation of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organised. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemised. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemised work and team based approaches. These include issues of professional socialisation which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.
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Evans, S. (2007). Silence kills: Challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16–19.
Abstract: The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals.
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Wilkinson, J. A. (2002). Creating a culture of workplace safety. Kai Tiaki: Nursing New Zealand, 8(6), 14–15.
Abstract: This study investigated the safety of working environments of a group of urban district nurses. Six district nurses were interviewed and participated in a focus group. The findings focus on the risks associated with client behaviour and with the organisational structure in which district nurses work. Recommendations for primary, secondary and tertiary prevention of harm to nurses working in isolation in the community are presented. The author describes her personal background in district nursing, which prompted the study.
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Lapana, S. (2007). Pa hi atu health model: A Tokelau perspective. Whitireia Nursing Journal, 14, 35–39.
Abstract: In this article, the author describes a health model aimed at providing health practitioners with a better understanding of Tokelau health concepts and values.
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