Litchfield, M., Connor, M., Eathorne, T., Laws, M., McCrombie,, & Smith, S. (1993). Direction for nursing practice and service delivery in the New Zealand health reforms. Report of the pilot study of the Wellington professional nurse care management project. Ph.D. thesis, , .
Abstract: Nursing practice as the process of health patterning with families in complex health circumstances was made explicit through a method of research praxis. Findings include cost in relation to quality of Nursing care. The research provides direction for development of integrated health care with the introduction of the family Nurse in a Nurse Care Management Scheme
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Litchfield, M. (1993). The process of health patterning in families with young children who have been repeatedly hospitalised. Ph.D. thesis, , .
Abstract: An exploration of the nature of nursing knowledge in practice. The praxis methodology was inspired by the Newman's theory of health as expanding consciousness and evolved through the process of the research. The methodology was eventually presented as both the process of research and practice. Five families were visited in their homes five times to talk about what was going on for them. All were experiencing a time of great upheaval in family life. After three visits a summary text was constructed merging researcher statements and parent quotes and given to the families. Through the subsequent reflective discussion significant insights into family pattern were shown in statements of intended action to change how health matters were managed with greater facility in family living. The process was presented as five themes with descriptors representing a non-linear, discontinuous progression: A moment of partnership: parameters of entry and closure, a timing of upheaval in family life, and an in-forming capacity through the bringing together of family story-telling and researcher's theory. An evolving dialogue: a progressive flow of enfolding and unfolding, and its embeddedness in contexts of socio-economic status, gender and health care culture. Recognising pattern: incidental revelations and an all-encompassing insight as the potential for action. Expanding horizon: moving from being on a treadmill trapped in the present without vision to having a view to a future, the presence of past and future. Increasing connectedness: a sense of inclusion, inter-dependence and generally, transformation in family life. This was a framework for personal practice
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Litchfield, M., & Noroian, E. (1989). Changes in selected pulmonary functions in patients diagnosed with myasthenia gravis. Journal of Neuroscience – Nursing, 21(6), 375–381.
Abstract: Patients with myisthenia gravis (MG) face major pulmary problems as a part of the disease process. In this descriptive study, changes in selected pulmonary functions (respiratory rate, negative inspiratory force, tidal volume and forced total capacity) in 14 patients diagnosed with mild or moderate MG were measured every two hours from 8.00 a.m. to 8.00 p.m. Females comprised 64% of the sample while 36% were males. All subjects received anticholnesterase medication, and some subjects received additional treatment modalities. Most of the subjects were non-smokers or previous smokers, but two subjects continued to smoke. Ninety-three recent of the sample had forced vital capacities less than 60% of their predicted values. Myasthenic forced vital capacities were significantly lower (p=.0000) than those predicted for normal subjects. The inspiratory force for the sample was low sat 8:00 a.m. as well as in females over 55 years of age. There was a wide variation in total volume to normal values derived from random tables and predicted equations ws not significant. Th major implications from this study are the need to assess pulmonary function in the hospitalized myasthenic every two hours, and the need for a program of coughing, deep breathing and sighing after medication administration when the muscles are strongest
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Litchfield, M. (1997). The process of nursing partnership in family health (Vol. 4).
Abstract: The study reconceptualises the process of nursing practice where health is expanding consciousness. The praxis methodology and design derive from the findings of the previous study (Litchfield, 1993) through which a framework for personal practice was articulated. The philosophical premises were hermeneutic and dialogic reflecting a narrative orientation within a participatory paradigm. Ontology and epistemology merge and language is fundamental. The findings from this subsequent study depict the process of modeling practice as a tetrahedron to show inter-relatedness of four facets, each defined completely by the others: partnership, dialogue, pattern recognition and health as dialectic. Five young families with complex health circumstances were preferred by Plunket Nurses and visited at hole to talk about health and the family. Th e process of health patterning ended with indication of insight as the potential for action; the partnership ended as the closure of the initial contract to provide a summary text to the family. Transformative change in family living was identified. The continuous analysis of the scripts of the evolving conversations and summary text showed the relational, dialogic processes were identified as vision – finding purpose to act in the here-and-now against the backdrop of past and potential of the future; and community – a sense of being connected, participant and relevant in society. This process of research, as if practice, presented health and caring as synonymous and core of the discipline of nursing
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Litchfield, M., & McCombie, M. - L. (1994). The introduction of an advanced nurse practitioner role in mental health: report of the evaluation research undertaken for the Mental Health Service of Capital Coast Health Ltd. Ph.D. thesis, , .
Abstract: The study was commissioned to define the role of Advanced Nurses Practitioner to inform the establishment of a clinical career pathway. Four new, loosely defined ANP positions were created and the role evolution over three months was described. The impact on the multidisciplinary team functioning was to be given particular attention. The research design was developed in collaboration with the ANP Project Team of the service. Data were derived from surveys of nurses in the units and other staff before and at the end of the 3 months period; interviews with the ANPs and official client advocates; daily journals and weekly logs kept by the ANPs; statistical records of patient loads and staffing. The findings presented the role as the interface of unit management and direct client care, with the ANPs orchestrating the activities of the unit. The ANPs developed the role differently according to quite distinct conceptualisations of nursing which influenced whether direct client care was pivotal or peripheral to the role. This had an effect on whether the strains of the service were seen as inhibitory of focal to the development of the ANP practice. There was little change in unit staff satisfaction. Attempts to incorporate client advocacy to determine change in client satisfaction were unsuccessful. The ANPs used the research as a process of role development
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Litchfield, M., Connor, M., Eathorne, T., Laws, M., McCombie, M. - L., & Smith, S. (1994). Family nurse practice in a nurse management scheme: a pilot service study for the health reforms. Ph.D. thesis, , .
Abstract: The independently funded 10 month pilot project demonstrated the autonomy of nursing practice for a new role family nurse. The findings were presented as the health experience of families in strife with complex health circumstances, a description of a beginning model for the nursing practice that addressed the needs of these families as their circumstances changed over time, and its cost-effectiveness. A caseload of nineteen families was found to be optimum. The evaluation research continued throughout as a form of praxis expressed as health patterning, a methodology developed in previous research (Litchfield, 1993). The family nurse'spractice demonstrated qualities common to all nurses: the caring relationship and fiscal responsibility. The unique practice was characterised by a professional partnership of limited duration: the families referred to the service in a predicament of strife, trapped in the immediate present, gained a view to a future, moved towards assuming control over health circumstances, seeking and using services with discernment, and increasing community as family/group members and citizens. Cost containment was achieved through: a) development of a co-operative approach amongst family members, between families and professionals, and amongst all health workers, and b) the families discerning use of services by anticipating a future. Through one family case, cost of saving over the 7 months with the family nurse was estimated as $4000, a possible saving of $16000 over 13 months if the family nurse had been involved earlier, and projected savings in the long term of over a million dollars. The satisfaction of clients, nurses and professionals was shown. The service was positioned within the new health system of health reforms
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van Wissen, K. A., Litchfield, M., & Maling, T. (1998). Living with high blood pressure. Journal of Advanced Nursing, 27(3), 567–574.
Abstract: An interdisciplinary (nursing-medicine) collaboration in a qualitative descriptive research project undertaken in the Wellington School of Medicine with New Zealand Health Research Council funding. The purpose was to inform the practice of nursing and medical practitioners. A group of patients were interviewed in their homes. Their experience of having a diagnosis of hypertension and prescription of long-term treatment requiring adjustment in their lives and the lives of their families is presented as themes.
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Litchfield, M., Clarke, M., Edwards, R., Richardson, F., Tansley, R., & Woodman, K. (1995). A description of the needs of people with cancer and support people. Ph.D. thesis, , .
Abstract: The report of a research project commissioned by the Wellington Division of the New Zealand Cancer Society to provide a foundation for policy to give direction to development of its services. The research approach and methodology had an ecological theory foundation. It involved a survey and in-depth interviews with people with cancer and those caring for them to understand their experience. Needs were identified from the data and presented according to three distinct phases in the course of living with cancer. People moved from the shock of diagnosis, through the time of treatment when usual living was suspended and focus narrowed on the intensive fight against the disease, then into a very different phase of on-going ?wait-and-see? time requiring a new way of living with uncertainty for both patient and carers. The last phase was where most of the unmet needs lay. Recommendations were made for services to provide a continuous caring relationship for patients and carers with a knowledgeable person from the point of diagnosis.
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Litchfield, M. (1979). Survey of child health care in primary schools in the Wellington area (Vol. 75). Ph.D. thesis, , .
Abstract: The study was undertaken as a project for the International Year of the Child. There was a need for information to identify what health care in needed in schools and to contribute to a review of the role of the nurses. Teachers and principals of all primary schools of the Wellington area were surveyed to describe the health care being provided and needed. Recommendations were made for school nurses who would support the health-related teaching by teachers, provide first aid and advice, and take an extended role for family health operating from a clinic in the school.
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Litchfield, M., & Laws, M. (1999). Achieving family health and cost-containment outcomes: Innovation in the New Zealand Health Sector Reforms. In Cohen,E. & De Back,V. (Eds.), The outcomes mandate: New roles, rules and relationships. Case management in health care today (pp. 306-316). St Louis: Mosby.
Abstract: The chapter presents the research findings of the 1992-1993 Wellington Nurse Case Management Scheme Project as a distinct model of nurse case management, which introduced a role and form of practice of a family nurse and a diagram of the service delivery structure required for support and relevant for the New Zealand health system reforms.
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Litchfield, M. (1992). Computers and the form of nursing to come. International Journal of Health Informatics, 1(1), 7–10.
Abstract: An invited paper for the initial issue of the IJHI. Adapted from a paper presented at the annual conference of Nursing Informatics New Zealand, 1991 (subsequently incorporated into the collective organisation, Health Informatics, NZ.
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Litchfield, M. (1986). Thinking through diagnosis: Process in nursing practice. Nursing Praxis in New Zealand, 1(4), 9–12.
Abstract: A paper following on from the paper “Between the idea and reality” (Nursing Praxis in New Zealand 1(2), 17-29) proposing the focus for the discipline of nursing – practice and research – is diagnosis. For nursing practice, diagnosis is a practice that collapses “The Nursing Process”; for research to develop nursing practice, diagnosis is one continuous relational process that merges and makes the separate tasks od assessment, intervention and evaluation redundant.
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Litchfield, M. (2006). Towards a people-pivotal paradigm for healthcare: Report of the Turangi primary health care nursing innovation 2003-2006.
Abstract: This report presents the findings of the developmental evaluation programme for the three-year innovation project. It includes the model of the integrative nursing service scheme with mobile whanau/family nurses as the hub of healthcare provision for a new paradigm of service design and delivery spanning primary-secondary-tertiary sectors. The form of healthcare the local people received, the nature of the nursing practice and role, service delivery and employment parameters required to support the nurses in practice are presented. The service configuration model subsequently gave the structure to Lake Taupo Primary Health Organisation with the hub of family nurses with a mobile comprehensive practice.
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Litchfield, M. (2002). The successful design and delivery of rural health services: The meaning of success. Christchurch: Centre for Rural Health.
Abstract: This is the report of the analysis of data from an in-depth survey designed by Sue Dawson, previously Rural Health Researcher in the Centre for Rural Health, and follow-up interviews. The study purpose was to construct a definition of “successful design and delivery of rural health services” as a step towards a measurement tool. Participants were grouped as general practitioners, nurses and community representatives. A format for a participatory approach to evaluation of rural health services is derived from the criteria of success identified, with its relevance for the implementation of the new Government primary health care strategy explicit. This format provided the basis for a subsequent evaluation case study undertaken in a small rural forestry township by the Centre for Rural Health.
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Litchfield, M. (1997). The language of nursing practice in hospitals. (Vol. Proceedings of the National Nursing Informatics Co).
Abstract: A paper presenting the findings of a small research project involving a group of self-selected senior nurses of Wellington Hospital to explore the nature of nursing practice in the care and management of hospitalised patients and to formalise the language that would acknowledge its significance in the current effort of hospitals to define patient care pathways. The nature of hospital nursing practice was described in themes of a generic process of nurse-patient care that articulates a distinct specialism of hospital nursing, whatever the hospital department in which nurses hold positions.
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