| Home | << 1 2 3 4 5 6 7 >> |
|
Doughty, L. (2004). Evaluation of the 2002 Auckland District Health Board: First year of clinical practice programme. Ph.D. thesis, , .
|
|
Mackay, B. (2004). An analysis of innovative roles in primary health care nursing. Ph.D. thesis, , .
Abstract: An analytical tool of Force Field Analysis was used to identify and describe forces influencing the development of innovative roles, including the nurse practitioner role, in primary health care nursing. At the commencement of the study an initial analysis of research, literature and policy identified forces driving or restraining the development of innovative roles. A mixed research method of surveys and focus group interviews with key stakeholders, namely nurses in innovative roles, general practitioners and nurse leaders, was then used to identify factors influencing development within the Northland District Health Board. Descriptive statistics and interpretative methods were used to analyse the data. A final analysis enabled a picture of forces influencing innovative role development to be presented. Driving forces reflected international trends and were strongly influenced by economics and a political imperative to reconfigure health care services towards a primary health focus. The Treaty of Waitangi was also a key influence. Driving forces had greatest impact on the development of new roles. Forces were identified as drives towards cost-effective evidence-based health care (effective services), equity for Maori, response to local needs and workforce reorganisation. The major forces restraining the development of innovative roles were reinforced by attitudes, customs and support systems. These forces were identified as poor professional identity and support, an outdated nursing image, inadequate education and training and slow transition from traditional practices and structures (tradition). These forces had a negative influence on support for innovative roles. Promotion of kaupapa Maori, involvement of the local community, local Maori and nursing in decision-making and promotion of a team culture have the potential to support further development of innovative roles. Political ideology and the Treaty of Waitangi will continue to be major influences directed through policy and the contracting and funding process.
Keywords: Nurse practitioners; Primary health care; Maori; Policy; Careers in nursing
|
|
Bland, M. F. (2004). All the comforts of home? A critical ethnography of residential aged care in New Zealand. Ph.D. thesis, , .
|
|
McLaughlin, K. (2004). Nephrology nursing: Early intervention in chronic kidney disease. Ph.D. thesis, , .
Abstract: This study explored the potential for extending the contribution nurses make in managing patients with chronic kidney disease as they progress to end stage kidney failure. In the context of a shortage of nephrologists and an escalating patient population suffering from kidney disease, the potential to include advanced nephrology nursing in early disease management was postulated. The literature was reviewed with regard to initiatives to reduce the progression of kidney failure and the prevention of associated complications. Local and international literature on advanced nursing practice and the nurse practitioner role was examined in relation to the management of chronic kidney disease. The introduction of the nurse practitioner in New Zealand could provide an ideal framework for independent nephrology nursing. Well-established nursing practice in dialysis, transplantation and pre-dialysis provide distinct scopes of practice in these areas for independent nursing in the future. It seems likely that these sub-specialties in nephrology nursing will be the first to experience the value of the nurse practitioner. The creation of early interventionalist nurse practitioners in nephrology health care would allow nurses to step outside these well-established sub-specialties, and provide new resources to help manage chronic kidney disease. A model of care was proposed that outlines how a nephrology nurse practitioner could work collaboratively with community health providers and the local nephrology health care team to manage the early stages of kidney disease.
|
|
Litchfield, M. (2004). Achieving health in a rural community: A case study of nurse – community partnership. Wellington: Litchfield Healthcare Associates.
Abstract: This study describes rural, nurse-led health services provided by the Takapau Health Centre (Central Hawkes Bay) and its outreach, Norsewood & District Health Centre. The study looks at its model of service delivery through to 2002. It examines the establishment, development, funding and management of the service, along with the nursing practice and the healthcare people received. The book is a snapshot of nursing initiative and survival through a decade of change in health policy and service funding and delivery. The information was subsequently used to move the health centre service into the new paradigm of primary health care launched in the New Zealand Health Strategy.
|
|
Joyce, M. (2004). The Strengths Perspective: Relevance and application to mental health nursing and crisis resolution work. Ph.D. thesis, , .
Abstract: This research paper aims to explore the contribution of the Strengths Perspective to mental health nursing practice. The Strengths Perspective emerged from the area of social work and is primarily concerned with emphasising the strengths and resources of the person, as they define them. The premise is that if a person is able to identify and call on those strengths then he or she is able to improve the quality of their life. The paper outlines the historical, philosophical and moral foundations of the Strengths Perspective and discusses the humanistic approach to mental health nursing. The aim is to demonstrate that the Strengths Perspective and mental health nursing have a strong alignment, particularly with regard to a person-centred approach to care. The influence and constraints of the biomedical model on both mental health nursing and strengths based practice is a theme of the paper. The contention is that the biomedical or pathological approach to care can often disable, not enable consumers of health care, whereas an approach that centres on a person and their strengths is more likely to empower and liberate. The paper concludes with a discussion of themes that emerged from reflection on the literature and propositions are then made about how mental health nurses might orientate their thinking and practice to utilise the Strengths Perspective to augment their clinical work.
Keywords: Psychiatric Nursing; Nursing models; Evidence-based medicine
|
|
Phillips, B. N. (2004). An interpretation of four men's experiences of suicidality. Ph.D. thesis, , .
Abstract: This study draws upon Gadamer's philosophical hermeneutics to explore the understandings that four men have had of their past suicidal experiences. The interpretations developed in this study, as far as possible, make explicit use of the author's own particular horizon of meaning as researcher and mental health nurse. In addition, by consciously bringing an anti-essentialist perspective of masculinity to this process, he explores the way in which gender impacts on men's suicidality. The primary source of information for this study is in-depth, open-ended conversations with four men of European descent in their middle adult years who were asked to talk about their past experiences of suicidality. The interpretations developed here show that for these men, the hermeneutic fusion of history, language, and sociocultural context, provided limited possibilities with which they were able to construe themselves as 'fitting in' with normative standards. These constraints, that are otherwise taken-for-granted and invisible, became explicit through their experience of ongoing victimisation. Furthermore, early understandings of these experiences became a potent horizon of meaning from which they then came to understand later difficult experiences. Victimisation became constitutive of an understanding of self as fundamentally different and (hierarchically)'less-than' other men. Ultimately, suicidality emerged out of a background of ever-present psychological pain accompanying a construction of self as being unable to see themselves as ever 'fitting in'. These men did not regard themselves as having recovered from suicidality, but remain in a process of recovering. This process did not mean figuring out how to 'fit in', or become 'normal' men, but rather, to live meaningfully as men in spite of not 'fitting in' with the sociocultural ideal. Recovering was a continual and idiosyncratic process, rather than an outcome of a specific technique or knowledge. The position taken in this study is that mental health nursing seeks to engage with people and work with them in collaborative, respectful, human relationships. It is argued that mental health nurses work with an individual's situated understandings rather than delivering prescribed treatment determined by diagnosis. Hence, viewing suicidality as socioculturally situated and historically emergent suggests mental health nurses must closely attend to the way in which we bring ourselves into relationships with our clients so that we are then able to create opportunities for change.
Keywords: Mental health; Psychiatric Nursing; Gender; Qualiltative research
|
|
Ryder-Lewis, M. (2004). Reliability study of the Sedation-Agitation Scale in an intensive care unit. Ph.D. thesis, , .
Abstract: This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the Sedation-Agitation Scale (SAS) in a natural Intensive Care Units (ICU) setting. The author notes that it is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience.
|
|
Brown, J. A. (2004). “Let my spirit always sing”: A descriptive study of how four elderly rest home residents view spirituality and spiritual care at the end of life. Ph.D. thesis, , .
Abstract: This descriptive, qualitative study, believed to be the first of its kind conducted in a New Zealand setting, focuses on spirituality issues of a spiritually vulnerable group of people, older people in residential care. Four rest home residents were recruited, to talk about their spirituality, spiritual needs and how their spirits were nurtured, the role of care staff in providing spiritual care, and their satisfaction with the spiritual care they were being offered. They were also asked to predict their spiritual needs as they were dying, their wishes for spiritual care in the perideath period, whether they had communicated these wishes to anyone, their views on advance planning to ensure these wishes would be met, and their comfort with the research process. The research data was collected from semi-structured, audiotaped interviews that were later transcribed. The spirituality of all participants had a strongly Christian focus that was revealed in the ten themes to emerge from a modified application of Colaizzi's analysis technique. The first themes to emerge were God as the focus of spirituality, God in control, the importance of relationship, and the purpose in life: serving God. Changes in spirituality with age, spirituality and residential care, and spiritual care: whose responsibility? were also identified as themes, as were end of life spirituality, planning for spiritual care, and the participants' satisfaction with the research process. All were able to articulate their spirituality, were generally satisfied with the spiritual care they were receiving, and had views on the spiritual care they wished to receive in the perideath period. Moreover, the participants trusted their families and the care staff to ensure that these wishes would be honoured. Recommendations are made for improving the spiritual dimension of care, and for further research.
Keywords: Older people; Rest homes; Spirituality; Nursing
|
|
Lowson, S. (2004). Sacred memories: Creative art therapy for children in grief. Ph.D. thesis, , .
Abstract: This paper explores the creative opportunities children might have to attend to their emotions and feelings following the death of a parent, grandparent or close friend. It presents the position that often children are left out of the process of caring for an adult when they are terminally ill and that has long term psychological implications. It also suggests that this has antecedents for the white New Zealand culture that were noted historically. In this research the author describes a personal journey that has shaped her current work as a hospice practice manager. The writer explores literature in psychological aspects of removing children from the dying room, creative therapies and the importance of sacred memories for the living child. The need to create memory that will embrace the child as a cloak enfolds them in their crisis stimulated the writer to offer a text in the personal narrative form. This text is presented in this form to enable other clinicians to access their own memories as survivors of grief in their own families. It is suggested that by enabling children and family to explore the importance of relating in the palliative phase of a person's life journey, good memories are created for the survivors.
Keywords: Children; Grief; Nursing; Terminal care; Psychology
|
|
Wilson, J. (2004). Walking the line: Managing type 2 diabetes: A grounded theory study of part-Europeans from Fiji. Ph.D. thesis, , .
Abstract: This study examines the experience of managing Type 2 diabetes from the perspective of part-European people from Fiji who have this disorder. A qualitative approach was used, and the methodology was grounded theory based on the theoretical perspective of symbolic interactionism. Data was collected from the in-depth interviews of nine participants who have been living with Type 2 diabetes. Text from the interview transcripts was analysed using the version of grounded theory advocated by Strauss and Corbin (1998). This process facilitated the discovery of 'Carrying On With Life And Living' as the main concern shared by part-Europeans managing Type 2 diabetes. It also identified the substantive theory of 'Walking The Line' as the core category and the basic social and psychological process by which part-Europeans resolve their main concern of 'Carrying On With Life And Living'. This was a three-stage process involving firstly 'Carrying on Regardless', secondly 'Attempting Balance in Time and Motion and Control', and thirdly 'Balancing, Unbalancing, and Recovering Balance'. The results of this study reveal that the social and historical contexts of part-European culture, such as heavy drinking, carrying on with life and living in the face of adversity, and taking traditional medicine impact significantly throughout their managing process. Findings of this study may contribute to development of some culturally aware strategies that could assist healthcare services to provide appropriate support, intervention, and education for part-Europeans with Type 2 diabetes. This study also addresses the lack of studies concerned with the management of Type 2 diabetes in Pacific peoples and serves to inform research initiatives and priorities set by the Health Research Council of New Zealand.
Keywords: Diabetes Type 2; Culture; Pacific peoples; Research
|
|
Dickinson, A. R. (2004). Within the web: The family/practitioner relationship in the context of chronic childhood illness. Ph.D. thesis, , .
Abstract: This study explores the phenomenon of the relationships between practitioners and families who have a child with a chronic illness. Using a heremeneutic phenomenological method informed by the writings of Martin Heidegger [1889-1976] and Hans-Georg Gadamer [1900-2002], this study provides an understanding of the meaning of 'being in relationship' from the perspective of both families and practitioners. Study participants include ten family groups who have a child with a chronic illness and twelve practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy who work with children with chronic illness. Narrative audio-taped interviewing was the means by which the participants told their stories about times that relationships worked well and when they did not. These stories uncover the every day realities of 'being in relationship' and provide another understanding of the relationship between family and practitioner.The findings of this thesis suggest that chronic childhood illness 'throws' families and practitioners together into a web of relationships that must work for the sake of the child. The relationship is primarily conducted between adults. Children are usually excluded. In order to understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential to the chronic illness journey, relationships are more successful when practitioners recognise the uniqueness of each family web. The nature of the relationship is often simple, yet it co-exists with complexity. This thesis proposes that a 'companion relationship' between practitioners and family may offer a more effective and satisfying way of working. It also challenges practitioners to consider the voice of children within health care relationships.
Keywords: Nurse-family relations; Chronically ill; Children
|
|
Ihimaera, L. V. (2004). He ara ki te ao marama : a pathway to understanding the facilitation of taha wairua in mental health services. Held by Lakes DHB Library (ROM), .
Abstract: A thesis submitted in partial fulfilment of the requirements for a Masters of Arts, Massey University, Palmerston North, New Zealand.
|
|
Therkleson, T., & Sherwood, P. (2004). Patients' experience of the external therapeutic application of ginger by anthroposophically trained nurses. The Indo-Pacific Journal of Phenomenology, 4(1), 1–11.
Abstract: There has been considerable public debate on the range of complementary health practices throughout the western world, perhaps especially in Australia, United States and Europe. Most often, the research critique of these practices is restricted to quantitative or non-user qualitative research methodologies. Consequently, there is a significant gap in the research profile of complementary health services that need to be addressed particularly in view of the rapid and ongoing increase in the use of complementary services, even in the face of sometimes adverse media publicity. This paper demonstrates the contribution that phenomenologically-based research can make to fill this lacuna by explicating, in detail, the client experience of a complementary health practice. The paper explores patient experience of a ginger compress, as applied by anthroposophically trained nurses, to demonstrate various therapeutic effects. Four key themes emerged including an increase in warmth and internal activity in the major organs of the body, changes in thought-life and sensory perception along with a greater sense of well-being and self-focus with the perception of clearer personal boundaries. These themes, emerging from a patient sample in New Zealand, compared favourably to the Filderklinik Study completed in 1992 in a large German state hospital.
Keywords: Anthroposophical therapy
|
|
Chenery, K. (2004). Family-centred care: Understanding our past (Vol. 20).
Abstract: Oral history accounts of the care of the hospitalised child in the context of family are used to argue that current practice paradoxes in family-centred care are historically ingrained. The article looks at the post-war period, the intervening years, and current practice, centred on the changing concept of motherhood throughout that time. The conflict between clinical expediency versus family and child needs is explored.
|