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Roy, D. E. (1995). Exploring the realities: the lived experienced of chronic rheumatoid arthritis. Ph.D. thesis, , .
Abstract: Rheumatoid arthritis is a chronic, systemic inflammatory disease of the connective tissues. People with rheumatoid arthritis often experience chronic pain, chronic fatigue and functional impairment for a large apart of their lives. The cause of rheumatoid arthritis is unknown, with three times more women than men being affected. There are many women who live with rheumatoid arthritis throughout much of their adult lives. Women with rheumatoid arthritis face the challenges and stresses of parenting, partnerships, and employment along with the need to cope with a chronic and increasingly debilitating disease.A review of the literature related to rheumatoid arthritis reveals a dearth of qualitative research, with few studies that focus specifically on women even though they constitute a significant percentage of the client group. Little is known from the clients' perspective of what it is like to live with chronic rheumatoid arthritis. This study, a single-participant case study using a phenomenological analysis, explores one woman's' reality of living with rheumatoid arthritis. As this woman's story unfolds, it is revealed how daily living with rheumatoid arthritis had been incorporated into a new way of being-in-the world. Her way of being-in-the-world is such that rheumatoid arthritis is very much a reality, impacting on most aspects of her life. Yet it does not dominate, as she continues with a very full and active life despite this disease
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Robertson-Green, B. (1993). Enabling choice, public health nurses' perceptions of their work with children and their families. Ph.D. thesis, , .
Abstract: This is a grounded theory study which looked at the perceptions of public health nurses regarding their work. This study focuses on their work with children within the context of their families and their communities
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McRae, B. H. T. K. (1998). Peer review: organisational learning for nurses. Ph.D. thesis, , .
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Lakeman, R. M. (1998). Psychiatric – mental health nurses on the internet. Computers in Nursing, 16(2), 87–89.
Abstract: This research began in 1995 with an e-mail survey of psychiatric / mental health (PMH) nurses who belonged to an e-mail discussion group. The original aims were to describe how PMH used and learned to use the internet, the benefits to their work, and how they saw the internet affecting their work in future. Data were analysed using content analysis techniques and findings published in a number of forums. In 1999 another survey using the same e-mail list was undertaken to explore how things had changed in terms of internet use and peoples visions of how the internet is likely to impact on nursing in the future. These data are the subject of continuing analysis
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Walker, J. (1998). The transition to registered nurse: the experience of a group of New Zealand degree graduates. Nursing Praxis in New Zealand, 13(2), 36–43.
Abstract: Since 1991, nursing profession in New Zealand has primarily been through a three year programme. The purpose of this study was to explore the issues faced by a group of degree graduates in their first year of registered nurse practice and to identify if the degree graduatesoutcomes (such as critical thinking, problem solving, reflection on practice, research, independent learning, and using cultural safety knowledge) had mediated this transposition process. Purpose sampling was used to invite five female graduates to take part in two focusgroups, one held at months and the other at 9 months after starting work. Qualitative data were collected using semi-structured questions and the taped interviews were analysed for themes. Five themes were identified: accepting responsibility, accepting their level of knowledge, becoming a team member, professional standards, and workplace conditions. Graduates were using their cultural safety knowledge but they perceived their knowledge of research was linked to further academic. Their ability to critique their own practice was evident but they found it difficult to challenge their colleagues' practice and the wider agency culture. Implications of the study are discussed in relation to nursing education and preceptor programmes and areas for further research are indicated
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Griffin, E., & Walker, J. Best health care practices for women with disabilities from the perspective of three community health practitioners.
Abstract: There is a dearth of information about community-based health promotion ortreatment services for women with disabilities in New Zealand. Little is also knownabout what health care providers perceive are the best ways to provide theseservices.This study examines the question “ What are the best health care practices fordisabled women?” An exploratory, descriptive approach was used to interview threehealth professionals (one nurse and two doctors) working in two different generalpractices, regarding their perspective of this question. These health professionalswere identified by women with disabilities as providing a quality service to them.Data was collected on their philosophy of care, definitions of disability, professionaleducation and range of primary medical and nursing care provided. The data wasanalysed for recurring themes related to each of the semi-structured interviewquestions. The characteristics of 'best health care' were found to include:client-centered care, communication and equality of care. The findings have beendiscussed in relation to the recommendations from the 1993 National AdvisoryCommittee on Core Health and Disability Support Services and feminist literature
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Walker, J. (1996). Co-operative learning: an effective teaching method for tertiary education? Ph.D. thesis, , .
Abstract: Tertiary education aims to develop specialist knowledge and the graduates' ability toapply the knowledge and skills to function effectively in their chosen career or work.Employers have criticised tertiary education when graduates cannot workco-operatively or independently in the work setting and teachers look for alternativesto lecturing to help develop these abilities. Cooperative learning (CL) is one suchmethod and this paper reports on a literature review and pilot study which exploredthe use of CL in a tertiary setting. The study was guided by three questions: 1) Whatarea the teacher's conceptions of effective learning and teaching? 2) How are theyusing CL and what is their role? 3) How are they assessing CL classes?Data was collected through in-depth interviews, using semi-structured questions,with three female and one male teacher from different disciplines in an urbanpolytechnic. Responses to each question were analysed thematically for recurringcodes and these were grouped into categories. Effective teaching was seen aswhere teachers facilitated the learning process by selecting appropriate teachingmethods, fostering classroom climate and monitoring learning. Effective learning waswhere students were actively engaged in the learning process and demonstratedtheir understanding and application of knowledge and skills. CL was used in avariety of ways and their role was to use strategies to foster the learning processand monitor learning. Assessment involved both individual and group presentations.Issues related to cooperative learning are discussed and recommendations forteaching made
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Walker, J. (1994). Learning psychomotor skills: Is Kolb's experiential learning cycle effective? Ph.D. thesis, , .
Abstract: The move to nursing degrees has encouraged educators to use student centredteaching methods which develop problem solving skills, critical thinking andreflection. Kola's Experiential learning cycle is proposed as one method to developsome of these skills. The study compared the effectiveness of three differentmethods of teaching the instillation of eye drops and application of an eye pad. Asample of 73 volunteers from a Diploma of Nursing programme were systematicallyassigned to one of three groups. The modified experimental design consisted of acontrol group (tutor demonstration and student practice), Kolb's group (teachingusing the experiential cycle) and the SDL group (self directed learning using writteninformation with no tutor instruction or feedback). Participants rated their confidence,competence and the amount of thinking, analysis, guidance and problem solvingbefore and after each method.Results for instilling eye drops indicated that there were no significant differences onthe pre-test ratings and a marginally significant difference (p=0.06) on the post testratings across the teaching methods. Results for the eye pad showed no significantdifferences on pre-test or post-test ratings across the methods. Students learnt by allmethods and the differences, if there were any, were not large enough to bedetected in this study. There was a significant difference in problem solving and tutorguidance across the methods due to the low ratings of the SDL group. There was nosignificant difference in thinking, analysis or partner guidance across the methods
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Walker, J. (1995). Learning physical assessment skills. Ph.D. thesis, , .
Abstract: Nursing students have only recently learnt in-depth physical assessment skills within degree programmes in New Zealand. The purpose of this qualitative study was to describe the experience of learning physical assessment skills for the first time from the student's experience. In exploring this experience it was hoped to uncover some of the factors, beneficial or not, which influence their learning process. Data was collected by two methods. Firstly through two non-participant observations of a class of sixteen pre-registration male and female nursing students at an urban tertiary institute. Secondly through taped in-depth interviews with a female and a male student, from the group, individually and then together. The data was analysed using coding categories suggested by Bogdan and Biklen (1992) and emerging themes related to the process of learning new knowledge and skills. The four themes identified were: students working at learning, tutors facilitating learning, students facilitating learning and learning in clinical practice
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Nelson, C. M. (1998). Nursing the stranger you know. Ph.D. thesis, , .
Abstract: Nursing the Stranger You Know demonstrates how combining aspects of nursing theory, the work of Ken Wilber, a leading writer in the field of transpersonal psychology and my own reflections have enhanced how I am able to experience and practice nursing in a primary health care setting.This study acknowledges and values the power of the connections which link us all together. The greatest strength of this work is that it shows, through the use of personal writing, how it is possible to nurse beyond the present and beyond the obvious when clinical, theoretical and self knowledge are all equally respected and incorporated into nursing practice
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Corbett, A. A study into the role of the school nurse.
Abstract: It was believed that the Registered Nurse in the position of school nurse had much to contribute with assisting teachers with health education, health promotion; and able to offer personal counseling and assistance with family and personal problems of individual problems. A nurse who approached the researcher on a matter of pay rates was not used in this way. Was this a general trend in secondary schools? What exactly was the work of the school nurse? Was there any commonality between the work of school nurses in secondary schools in the Hamilton area? Were all schools nurses qualified as Registered Nurses? The role of the school nurses therefore appeared to be a suitable topic for a research project
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Margetts, M., Cuthbertson, S., & Streat, S. J. (1995). Bereavement follow-up service after fatal critical illness. Ph.D. thesis, , .
Abstract: Fatal illness is often short. Communication between patient and family is impaired and how to best meet family needs is unclear. We began a follow-up service to determine current next-of-kins outcomes and remedy service deficiencies. A critical care nurse identified deaths from our data base and completed a structured telephone interview with the next-of-kin. There were 374 admissions from 1/1/95 – 17/5/95, 55 died. Next- of-kin of 52 patients (M29, age 19-88 median 52) were contactable 16-70 (median 33)days later. All (defacto/wives 18, husbands 9, mothers 9, daughters 8, others 8) consented to interview (5 -80, median 15 minutes). Forty-nine had resumed normal home activities and 23/25 workers had returned to work. Thirty-three still had disturbed sleep, three were taking hypnotics. Twenty-four had had contact with their general practitioner because of the death (six were prescribed sedatives or hypnotics). Nineteen had financial problems. Forty-seven described DCCM care positively, 35 specifically (nursing care and compassion 15, communication 8, flexible visitors policy8) but 13 had particular difficulties (communication 4 , waiting 2, facilities 4) and 4 serious non-DCCM issues. Forty-six considered themselves well informed and understood well the sequence of events. Forty-eight identified family and friends as primary support. Three requested information about another agency (counseling), 9 asked us to contact as further relative. A telephone bereavement service is well received by next-of-kin. Most families members resolve their early grief without external agencies but sleep and money are problems. We have improved our facilities and are addressing communication and cultural issues
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Margetts, M., Cuthbertson, S., & Streat, S. J. (1996). Bereavement follow-up – its impact on practice. Ph.D. thesis, , .
Abstract: Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care
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Key, R., Habashi, S., Baber, C., Cuthbertson, S., & Streat, S. J. (1994). Long-term follow-up after Bjork flap tracheostomy. Ph.D. thesis, , .
Abstract: Because of concern about long-term complications of bjork flap tracheostomy we followed-up 136 intensive care patients who had Bjork flap tracheotomy in 1992 a median of 117 (range 5-402) hours after intubation. Twenty died in hospital, none as a result of tracheostomy. Twenty- six patients were lost to follow-up and eleven declined. The remaining 79 had measures of health status, a quality of life questionnaire, respiratory function testing and physical examination of the neck and upper airway 9-27 months (median 14) later. Various health status measures deteriorated in 9 to 51 of 77 patients. Forty-two of 77 patients were taking prescription medication and 15/32 smokers had stopped smoking. FEV1, FVC and FEV1/FVC were significantly reduced from predicted normal (n=70, 2.8+ 1.1 vs 3.2 +0.9 p<.0001, 3.7 + 1.3 vs 4.0 + 1.0 p<.0001, 76 +11vs 79 +3 p= 0.035 respectively). Pulse oximetry was normal (>92%) in 73/74 patients tested. The median horizontal scar dimension was 45mm (range 20 to 75 mm). Nine had a median vertical scar dimension 15mm (range 8 to 25mm). Nineteen scars were hypertrophic, 56 were tethered. Two patients had already undergone tracheal scar revision at follow-up and further 13 accepted scar revision. Ten patients had abnormal voice examination, four abnormal cough, two stridor, three vocal cord lesions, three tracheal polyps and fourteen asymptomatic tracheal narrowing from 10-60% (median 25%) of the tracheal luminal diameter. Patients surviving critical illness with bjork flap tracheostomy have reduced quality of life and respiratory function and poor cosmetic result but a low incidence of important airway problems
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Key, R., Cuthbertson, S., & Streat, S. J. (1995). Critical care survivors follow-up service. Ph.D. thesis, , .
Abstract: The extent of early remediable morbidity after critical illness is unclear. We began a follow-up service to determine outcomes, facilitate rehabilitation and remedy service deficiencies. A critical care nurse identified hospital survivors (DCCM and hospital databases), completed a structured telephone interview with the patient and intervened according to predetermined guidelines. Of 261 admission 1/1/95 29/3/95 50 died in hospital (39in DCCM). Of 211 hospital survivors (M115, age 15-84 median40) 31 could not be contacted, one died at home and 179 contacts were made 21- 120 (median 51) days after DCCM. One refused interview, 178 interviews took 8-60, (median 15) minutes. Only 68/178 had resumed normal activities and 26/78 workers had returned to work. Seventy patients had contacted general practitioners because of critical illness sequelae. One hundred patients gad 191 problems (including unhealed wounds29, pain 28, impaired mobility26, neurological deficit 178, infection 10 weight loss 9, tiredness 6 depression 5, sleep disturbance 3, others 57). Sixty-five described DCCM staff as helpful, 37 had complaints (hallucinations 6, staff behaviour5, restraints5 sedation/analgesia inadequate5 or excessive 2, poor communication3, fear3, noise 2 other 4) and 5 raised serious non-DCCM issues. Forty-four patients were called again 6-84, median 42 days later when 69/112 health problems had resolved but 29/44 patients had not resumed normal activity. Four attended a clinic and were referred to other services. A follow-up service is well received. Morbidity is common but improves within three months after critical care. We are addressing service issues
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