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Hetaraka, B. (2006). A study of nurses working in a community development model. Ph.D. thesis, , .
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Elliott, M. M. (2006). Model of care development: Moving between liaison and complex care coordination in the community health setting.
Abstract: Healthcare systems in New Zealand and the western world are grappling with changes with an aging population; increased use of technology resulting in shorter inpatient stays, increasing chronic illness rates and people with complex health needs. Supporting people through the health system and meeting their needs is an aim of all services. Trying to support seamless transition and manage complex care requirements has become important for community health services. In the district health board, where the author works, the role of Liaison Nurse/Complex Coordinator was established to support this. This role has become important in reviewing what the best model of care for Community Health Services is and how to describe the current practices in this context in an appropriate way. The first section of the report reviews the literature and current practice in relation to liaison nursing. This section explores how to make the role clear and identify its clinical and organisational effectiveness, drawing out the key elements and aspects for this role that will contribute to a model of care. The second section progresses onto the clinical work related to managing patients with chronic illness and complex needs. Utilising literature to inform current practice when supporting patients through health transitions to achieve seamless care and identifying key aspects required to manage this and adding these aspects to the model of care. Following this, a review of current care models available and in use in the health care systems is undertaken. There are some elements and aspects similar in these models and those explicated in the previous sections. Finally a model of care is developed bringing all the key aspects and elements together. This model describes the practice of Liaison/Complex Coordination role in community health service in New Zealand and identifies the need for care, provision of care, outcomes of care provided and impact for the service and organisation. The author suggests that this model is relevant for any liaison or complex coordination role and could be a basis for other models of care to expand upon the specific needs for their services.
Keywords: Community health nursing; Nursing models
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Grayson, S., Horsburgh, M., Lesa, R., & Lennon, D. (2006). An Auckland regional audit of the nurse-led rheumatic fever secondary prophylaxis programme. Access is free to articles older than 6 months, and abstracts., 119(1243).
Abstract: The researchers assessed the compliance rates with the rheumatic fever secondary prophylaxis programme established through the Auckland Rheumatic Fever Register and managed by community nursing services in Auckland. They undertook an audit of the 1998 and 2000 Auckland Rheumatic Fever Register data to establish the compliance rates of patients with the rheumatic fever secondary prophylaxis programme. The sample included all patients on the Auckland Rheumatic Fever Register during this time. Results showed compliance rates across the three Auckland DHBs ranging from 79.9% to 100% for individual community nursing offices. They found that a community-based nurse-led secondary prophylaxis programme for rheumatic fever heart disease is able to deliver excellent patient compliance levels. Secondary prophylaxis is the WHO-recommended cost effective first step to rheumatic fever/rheumatic heart disease control. Community health workers have a key role to play in facilitating this compliance.
Keywords: Community health nursing; Patient compliance
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Clissold, C. (2006). How discourses stifle the Primary Health Care Strategy's intent to reduce health inequalities. Ph.D. thesis, , .
Abstract: The Primary Health Care Strategy (PHCS) has a stated commitment to defined populations who suffer disproportionately from ill health. This thesis examines whether some prevailing discourses actually decrease the focus on health inequalities. A study of the nursing and medical media found that it focused predominantly on professional and industrial issues, leaving health workers focused mainly on their own professional interests, rather than considering the effects on health inequalities. She goes on to suggest that current Ministry of Health discourse values decentralised community health decision making. This may gloss over factors in community health which are affected by Government policy such as employment policy, and thus should be dealt with centrally by legislation. These factors have been found to be the most pertinent in health inequalities. So while models of community partnerships may seem to place communities as agents in their own health, this downplays the determinants of health which are beyond their control. Having shown that discourse can decrease the focus on health inequalities due to other professional and political drivers, the author then looked at health initiative concepts which are effective, efficient and equitable given the current set up of PHOs and nursing innovations.
Keywords: Community health nursing; Policy; Primary health care
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Weidenbohm, K. (2006). Pioneering rural nursing practice: An impact evaluation of a preventive home visiting service for older people. Ph.D. thesis, , .
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Ramsamy, K. (2006). Colonisation: The experience of a psychiatric nurse through the lens of reflective autobiography. Ph.D. thesis, , .
Abstract: The author points to the oppression of colonisation living on in the daily lives of colonised people, and goes on to say that it is vital for nurses to understand the effects of that oppression, as well as the restrictive impacts, and dislocation from one's land and culture to-day. Nurses come from both the descendants of colonisers and the colonised. This thesis is a journey and a quest for insights into the impacts and significances of colonisation by looking at historical and socio-political contexts that have bearing on the health of colonised people who remain mostly powerless and marginalised. It is prompted in response to a cultural safety model which advocates that nurses should become familiar with their own background and history in order to be culturally safe in practice. This reflective autobiographical account is a personal effort and provides the foundation for an exploration of issues during nursing practice encounters, from a colonised ethnic minority perspective. The method was informed by Moustakas research approach and Johnstone's Reflective Topical Autobiographical process. The selection of specific events are deliberate, to make visible some of the many barriers that exist within our health structures as pertinent issues for non-dominant cultures that remain on the margin of our society. Maori issues provide a contrast and became a catalyst for the author while working for kaupapa Maori services. The intention of this thesis is to generate new knowledge about what it means to be a nurse from an ethnic minority working in a kaupapa Maori mental health service, and to encourage other nurses to explore these issues further. Some recommendations are made for nurses in the last chapter.
Keywords: Cultural safety; Colonisation; History; Nursing
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Arcus, K. J., & Wilson, D. (2006). Choosing Whitireia as a political act: Celebrating 20 years of a nurse education at Whitireia Community Polytechnic 1986-2006. Whitireia Nursing Journal, 13, 12–24.
Abstract: In 2006, Whitireia Community Polytechnic celebrates 20 years of tertiary education. Nursing was one of the first courses to start at the new Parumoana Community College in February 1986. Oral histories, gathered from the women who have been the leaders of the undergraduate nursing programme throughout these two decades, form the basis of this article.
Keywords: Cultural safety; Curriculum; Nursing; Education
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McEldowney, R. A., Richardson, F., Turia, D., Laracy, K., Scott, W., & MacDonald, S. (2006). Opening our eyes, shifting our thinking: The process of teaching and learning about reflection in cultural safety education and practice: An evaluation study. Wellington: Victoria University of Wellington.
Abstract: The purpose of the research was an evaluation of practice exemplars as a reflective process in teaching and learning about cultural safety. Six Maori, two Pacific and five Pakeha students, ranging in age from 30 to 40, took part in the research. The research findings revealed five sub themes: personal safety, power/ powerlessness, reflection, teaching and learning and cultural safety. The presentation, while acknowledging that cultural safety shared some commonalities with culture care theory, highlighted differences between the two. These included that cultural safety was explicit in identifying the inherent power of the nurse in health care relationships; related to the experience of the recipient of nursing care, and extended beyond cultural awareness and sensitivity; provided consumers of nursing services with the power to comment on practices; and contributed to the achievement of positive outcomes and experiences for them. It outlined the characteristics of a culturally safe nurse as a nurse who had undertaken a process of reflection on her/his own cultural identity and who recognised the impact their personal culture had on client care.
Keywords: Cultural safety; Nursing; Culture
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Greenwood, S., Wright, T., & Nielsen, H. (2006). Conversations in context: Cultural safety and reflexivity in child and family health nursing. Journal of Family Nursing, 12(2), 201–224.
Abstract: This article outlines some key aspects of the practice of a number of nurse educators and researchers, and their commitment to the needs of their specific region. The group has been based at the Waikato Institute of Technology (WINTEC) over the last decade and have worked collaboratively across primary health, cultural safety, and child and family health domains of the nursing curriculum. They share a common philosophy underpinned by notions of diversity and health equity. The philosophy informs their theoretical inquiry, practice and research interests, and pedagogical concerns. In this article, the nurse researchers begin by situating themselves within the region, its people, and influences before moving into a consideration of the wider political and policy environment. They then consider the destabilising effects of cultural safety education and the tension between biculturalism and multiculturalism in their context. Finally, they reflect on how these ideas inform their work with postgraduate child and family nurses.
Keywords: Cultural safety; Nursing; Education; Curriculum; Nursing philosophy; Teaching methods; Biculturalism
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Smye, V., Rameka, M., & Willis, E. (2006). Indigenous health care: Advances in nursing practice. Contemporary Nurse, 22(2), 142–154.
Abstract: In this introduction to a special issue on nursing with indigenous peoples, the authors affirm the need for continued application of tools and strategies for thinking critically about issues of culture, history and race. Without these things, evidence of discriminatory policies and practices in the health system remain hidden to many health professionals. Attention to socio-political structures is as essential to promoting health and preventing illness as are nurses' activities with the individual clients. To develop critical consciousness in nursing requires educational strategies and frameworks that focus on the responsibilities and implications of practicing nursing in a postcolonial context where race and power continue to create patterns of inclusion and exclusion in health care settings. The authors suggest that many contemporary nursing programmes fail to provide such strategies and frameworks, and argue that nursing must view critical analyses of these issues as central aspects of nursing education, research, theory and practice. They go on to engage with the notion of cultural safety as a means of fostering a critical political and social consciousness in nursing to create an opportunity for social transformation.
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Woodgyer, A. R. (2006). Living without the song of the tui: A nursing lecturer's experience in India facilitating a New Zealand degree programme for registered nurses. Ph.D. thesis, , .
Abstract: This research considers the issues raised by the transfer from New Zealand to India of a degree for registered nurses. In the context of globalisation and the continuing migration of nurses, many countries are actively facilitating the transfer of educational programmes from other countries into their own. This transfer brings with it particular challenges for educators establishing and implementing programmes in a new environment and culture. Based on the experience and reflections of one educator involved in such a transfer, this research considers pedagogical issues such as addressing cultural safety in course content and delivery, expectations of teaching and learning styles, as well as the ethical issues raised by transferring a programme to another country in order to facilitate nurses' migration from it.
Keywords: Curriculum; Nursing; Education; Culture
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Voice, D. M. (2006). Everyday district nurses' experiences revealed through distillation: Palliative care in the community. Ph.D. thesis, , .
Abstract: This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. The author notes that this research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). She goes on to say that it has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting.
Keywords: District nursing; Palliative care; Community health nursing; Nursing
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Patel, R. (2006). Evaluation and assessment of the online postgraduate intensive care nursing course. Ph.D. thesis, , .
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Hickson, E. K. (2006). Developing clinical learning environment evaluation tools using an action research methodology. Ph.D. thesis, , .
Abstract: The author notes that learning nurses require real clinical experiences in order to apply learnt theory to actual practice. Clinical learning environments have consistently been found to function variably and sub-optimally for both learners and teachers. In order to improve the quality of the clinical learning environment it is necessary to first evaluate how effectively a clinical learning environment is functioning. A number of different methodologies have been used to evaluate clinical learning environments, a recent and successful method being the use of questionnaires or clinical learning environment evaluation tools. The objective of the present study was to develop clinical learning environment evaluation tools for use in a New Zealand hospital health service. Four tools appropriate to evaluate the clinical learning environment from the different perspectives of any type of clinical learner, clinical teacher, clinical manager and programme co-ordinator or nurse lecturer were developed. Six newly graduated nurses, three senior nurses, and the researcher were involved in the development of the evaluation tools over a five month period. A participatory action research methodology was employed. The resultant tools had a unique local focus and were suitably similar to other internationally developed tools. After testing the clinical learning environment evaluation tools, it is hoped that the implementation of the tools will support all stakeholders to understand and consequently optimise the functionality of their clinical learning environment.
Keywords: Education; Nursing; Teaching methods; Evaluation
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Blackmore, L. A. (2006). Triaging patients away from the emergency department: A review of the issues.
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.
Keywords: Emergency nursing
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