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Honey, M. (2007). Teaching and learning with technology as enabler: A case study on flexible learning for postgraduate nurses. Ph.D. thesis, , .
Abstract: The aim of this study was to explore the practice of flexible learning for postgraduate nurses. Flexible learning is a contemporary approach to learning that utilises the benefits of technology. Flexible learning can be understood as a continuum, from fully on-line or web-based courses, to those that are on-campus and supported by technology. Internationally, the rise of flexible learning has been influenced by increased demand for higher education and competition among providers within the context of reduced education funding. The study population, New Zealand postgraduate nurses, are accessing higher education in increasing numbers to advance their practice and to position themselves for new roles and opportunities. These are often experienced nurses yet inexperienced in higher university education, who combine study, work and other commitments. The study employed a qualitative case study design because it enabled multiple perspectives to be gained. Data included documentation, participant observation, survey, students' assessed work and interviews with key stakeholders: student, teacher and the organisation. Thematic analysis was conducted on reviewed documentation, participant observation and interviews. The study identifies the elements that contribute to flexible learning and the interconnectedness between the elements within the dynamic context of a university to illustrate that effective flexible learning can be provided by using a student centred approach to ensure the learning needs of postgraduate nurses are met. The author concludes that flexible learning improved access, choice, and provided an emphasis on the student as central to learning. In response to these findings the weighting of recommendations are toward the organisation as, the author suggests, it is at this level where greater change can be made to improve support for flexible learning provision.
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Wilson, M. J. (2007). Strategies for the nurse leader to enhance nursing practice and promote workforce development within an interdisciplinary alcohol & other drugs team. Ph.D. thesis, , .
Abstract: This dissertation had two main aims. The first was to explore the literature from which nurse leaders of alcohol and other drug services might develop their leadership skills so as to enhance nursing practice within an interdisciplinary alcohol and other drug team. The second was to further utilise these skills to develop a 'toolkit' which would assist in the successful management of the team but would also aid with workforce development. In addition, this dissertation was linked to the Nursing Council of New Zealand Competencies for the Registered Nurse Scope of Practice (2005) and Competencies for Advanced Nursing Practice (2001). This dissertation provides direction for the nurse leader wishing to develop their toolkit. Implications for the advancement of nursing are suggested.
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Haitana, J. (2007). Building relationships: A qualitative descriptive study reflective of the day-to-day experiences of one group of preceptors in a provincial hospital in New Zealand. Ph.D. thesis, , .
Abstract: Research suggests that the experience of being a preceptor can be rewarding, but there are challenges which may impact on their ability to fulfil the preceptorship role. In an effort to understand the experiences of being a preceptor and the factors that impact on that role, a qualitative descriptive study was undertaken in a small provincial hospital in New Zealand. A purposeful sample of five registered nurse preceptors completed semi-structured audio-taped interviews. Seven common categories were developed from the data – willingness to engage, building a relationship, letting go, support, workload, students in the clinical setting and making judgements. The author notes that this research has highlighted that preceptors need prior notice that they are going to be having student nurses so that they can be better prepared; preceptors and student nurses also need to be rostered together for the whole placement to allow a one-on-one relationship to develop. Preceptors would benefit from having a lighter workload during the first few days of preceptoring as then they can spend more time teaching the student. Schools of nursing and hospitals also need to have an ongoing collaborative relationship in planning and supporting the preceptorship program; this would further support preceptors in their role. The lecturer from the school of nursing needs to be contactable and available to both the preceptor and the student to clarify any misunderstandings and as a resource should any problems arise.
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Lindley, G. (2007). Using frameworks to critically analyse the advancement of rural practice: One nurse's experience. Ph.D. thesis, , .
Abstract: The process of describing her scope of practice led the author to become interested in just how she has advanced her practice and the journey that unfolded. The author was introduced to a number of models or frameworks and these frameworks have been critiqued within this dissertation.
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Lesa, R. (2007). Advanced physical assessment skills: Factors that influence registered nurses' use of skills in the clinical setting, on completion of an advanced health assessment course. Ph.D. thesis, , .
Abstract: Traditionally the use of advanced physical assessment skills when assessing a patient or client has been the domain of the medical profession. The last few decades has seen many changes in health provision that have influenced nursing practice, as a result of the social and economic trends impacting on New Zealand society. A notable change in nursing practice has been an increased emphasis on the use of advanced physical assessment skills by registered nurses, as an expected part of the registered nurse's health assessment. Nurses in the United States, and more recently Canada and Australia, readily include these skills as an expansion of their health assessment into their nursing practice. The purpose of this research is to investigate whether New Zealand registered nurses have done the same. The factors that influence the registered nurses' use of these skills are also explored. This descriptive design was chosen in order to focus on exploring and describing this phenomenon in a holistic fashion. Data collection involved one hour semi- structured interviews with seven participants who all completed the same postgraduate advanced health assessment educational course. Three themes were identified as influencing the use of advanced physical assessment skills; the registered nurse's work environment, the registered nurse's attributes and the registered nurse's original nursing education. The findings from this research have implications for nurses in practice and nurse educators, in both undergraduate and postgraduate education.
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Stewart, C. M. (2007). “Caring as the heart of nursing education”. Ph.D. thesis, , .
Abstract: Literature and discussion on the role of caring theory in nursing has been in evidence for at least the past 30 years. Many nursing theorists have identified caring as the heart of nursing. Nursing is a profession involved and concerned with relationships. These relationships begin in the schools of nursing, and are continued into the clinical practice setting. Curriculum development is focused on ensuring nurses are prepared for the real world of practice. It is the author's belief, that nurses who receive their education in an environment where caring is modelled and evidenced throughout the curriculum, become nurses who continue to practice in a caring way. This dissertation will demonstrate that Swanson's (1991) five caring processes provide a framework to evidence caring practice within a nursing curriculum. The author believes this topic needs to be discussed as schools of nursing continue to review their curricula to prepare nurses for an ever changing and challenging health environment. This dissertation explores the question, 'If caring is at the heart of the profession of nursing, is it also at the heart of nursing education?' The author's objective is to inform the reader, and perhaps encourage educators to be courageous in the demonstration of caring practice, and in the development of caring curricula.
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Skally, M. H. (2007). An exploration of the preparation of New Zealand nurse educators for their role in teaching postgraduate clinical nursing courses. Ph.D. thesis, , .
Abstract: Little is known about the preparation of New Zealand nurse educators teaching clinically focused postgraduate programmes. This research gives an insight into their world and the preparation they had in order to fulfil their roles. A review of the literature on nurse educator preparation revealed a dichotomy of preparation nationally and internationally. This study was carried out to inform the New Zealand nursing profession on the preparedness of its educators teaching clinical nursing postgraduate programmes. It was the author's assumption that nurse educator preparation lacked strategic direction and was not nationally uniform. The research expected to answer how and to what extent New Zealand nurse educators teaching clinical nursing postgraduate courses at NQF Level 8 are prepared and supported for their teaching role. This research used an exploratory descriptive survey methodology and was underpinned by a conceptual framework. The conceptual framework, referred to as the critical elements of nurse educator preparation (CENEP), contained four key concepts, support, educational preparation, personal attitudes and experience. These concepts informed the design and construct of a questionnaire to determine the level of preparation of New Zealand nurse educators teaching clinical postgraduate programmes. A total of 89 postal questionnaires were administered resulting in a response rate of 46% (N=41), however, four questionnaires were excluded leaving a sample size of 37. Results of this research reveal a culture where nurse educator preparation lacks uniformity and consistency. Individually, New Zealand nurse educators were found to be highly qualified for their positions and motivated and enthusiastic about their roles. However, 40% of respondents did not hold a teaching qualification. Results from this research revealed a pattern of clinical training for postgraduate nurses that was immersed in the world of the academic institution. This research study is limited and cannot be generalised to the entire population of nurse educators teaching clinical postgraduate programmes. However, some valuable insights have been gained into a previously unexplored area, and recommendations have been made for the future direction of preparation for nurse educators teaching clinical postgraduate programmes in New Zealand.
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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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Kinniburgh, L. (2007). Treaty of Waitangi education: A pakeha woman's reflections on her journey. Ph.D. thesis, , .
Abstract: This thesis uses an autoethnographic method to describe the author's personal journey and the influences on teaching the Treaty of Waitangi in the School of Nursing at Otago Polytechnic, from 1985 to 2005. The author starts this exploration as a beginning teaching practitioner in 1985, and continues on with her attendance at the original workshop for trainers by Project Waitangi in 1990. She discusses the influences of her studies towards a Bachelor of Arts at Otago University, through the development of School Charters which influenced her children's schooling and through the process of teaching and facilitating the workshops for Treaty education, until her position in the School of Nursing changed in 2005. She discusses through reflection, the personal influences, the socialisation process of teaching the history of Aotearoa New Zealand to students, the influences of nursing education on Treaty education, the influences of Irihapeti Ramsden's relationship to her journey and also her lecturers at university. She also traces her journey of beginning teaching practice. The author identifies this work as providing a starting place for potential research into the experiences and reflections of nurse educators over this period of time, and across other educational institutes and disciplines. The experiences of students from this teaching would also add to the profession's and the country's knowledge about the relationship of the Treaty of Waitangi to both education and health.
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Dorofaeff, M. J. (2007). Shared status and advocating practices: Nurses who work with clients who have a co-existing intellectual disability and mental health problem. Ph.D. thesis, , .
Abstract: This research is informed by the interpretive phenomenology of van Manen, and explores the lived experience of nursing from the perspective of nurses who provide care for people with a co-existing intellectual disability and mental health problem. Although nursing research is commonly informed by phenomenology, there is a dearth of literature of any description written from the perspective of nurses who provide care for people with intellectual disabilities and mental health problems. As a result of the closure of many large institutions in New Zealand there are not many nurses who work with people who have intellectual disabilities and co-existing mental health problems. The study participants were four nurses purposefully selected because they provided care for people with intellectual disabilities and mental health problems. Data was collected using semi-structured interviews, and the researcher identified and wrote about the recurring themes in the transcribed interview data, which best captured the lived experience of the participants. The themes were: criticism of services, holistic caring, working with the client, issues of status, need for specialist knowledge, enduring relationships, diagnostic issues, advocating, modelling good practice; and working alongside. After further analysis the themes were encompassed within the larger interrelated themes of “Status and positioning” and “Advocating practices”, and finally within a single theme of: “The status and positioning of the nurse and the client leads to advocating practices.” These themes were found to be consistent with the nursing literature and with the researcher's own lived experience as a nurse who works in a specialist mental health intellectual disability service. The findings of this research have implications for a number of groups in New Zealand. Among the author's conclusions are that input is required from the Nursing Council of New Zealand, the nursing profession, nurse educators and the government to raise the status of clients with co-existing intellectual disabilities and mental health problems and the nurses who work with this client group. In addition, the roles for nurses who work with this client group are emerging and are likely to be diverse and there is a need for further research to capture the different experiences of these nurses.
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Manning, J. (2007). Skin-to-skin care of the very low birth weight infant: Taking a risk and making it happen. Ph.D. thesis, , .
Abstract: Parent-infant skin-to-skin care has become an advocated aspect of care in neonatal intensive care units nationally within New Zealand and internationally. However the implementation of this care by nurses can be limited by a number of factors within the practice environment. This dissertation presents a critical analysis of literature alongside reflection on the author's own practice experience to explore factors that may be constraining the use of skin-to-skin care with the very low birth weight infant in the neonatal intensive care unit. These factors are examined through a lens of risk taking behaviour underpinned by the grounded theory work of Dobos (1992). The concept of risk is explored in order to develop an understanding of why, in the author's view, the practice of skin-to-skin care of very low birth weight infants may have declined in recent years. For neonatal nurses skin-to-skin care of the very low birth weight infant presents challenges related to the environment, physiological stability of the infant and changes over the past 10 years in the clinical management of very low birth weight infants. As progress is made toward the design, development and eventual move to a new unit in Dunedin recommendations pertaining to the change in physical space, the introduction of a structured model for nursing care and implications for nursing practice development in relation to skin-to-skin care are described.
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Lewis-Clarke, G. M. E. (2007). Whanau and whanaungatanga issues affecting Maori achievement in tertiary nursing education.
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Feather, A. (2007). What is so hard about a drug calculation? An exploration into my experience of teaching the competency of drug dosage calculation to the undergraduate nursing student. Ph.D. thesis, , .
Abstract: This dissertation was written to promote the author's understanding of the development of drug calculation competency in the undergraduate student nurse. It explores and critiques the literature surrounding the topic and examines the differing teaching methods that are currently used to promote this competency. Findings from the literature were compared to her experience of teaching drug dosage calculation competency to second year undergraduate nursing degree students. This dissertation suggests that drug dosage calculation may be an ongoing problem for nursing students not only during their course of study but also post registration. It appears that age and educational background may be factors in determining whether or not the student will truly master the concept. Although highly debated, it does appear that the use of a calculator assisted the nursing students within the author's class with their arithmetic operation. However, problems associated with conceptual understanding remain notable. The recommendations from this dissertation include the use of varied methods of instruction, integration of both the theory and practical components and the possible use of the dimensional analysis method in the teaching of drug dosage calculation. The author suggests that further research is required both locally within the School of Nursing where she is employed and nationally to fully examine the extent of this issue. Research which is not only focused on the student's calculation ability and its progression over the course of their study but which also allows the School to collate data on age, educational background, culture and learning style would allow lecturers to gain greater insight into student competency, progress and learning needs. She goes on to say that the continued ongoing exploration of her own practice utilising action research is also required as this would assist her in meeting the needs of students and lead to an overall improvement in her practice.
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Watson, S. L. (2007). Attitudinal shifting: A grounded theory of health promotion in coronary care. Ph.D. thesis, , .
Abstract: Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.
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Marshall, K. (2007). Enteral nutrition within 72 hours after spinal chord injury: Complexities and complications. Ph.D. thesis, , .
Abstract: Good nutrition is essential following acute spinal cord injury. Poor nutrition can lead to the deleterious effects of protein-calorie induced hypermetabolism and poor functional and rehabilitation outcomes. Nutritional management for patients with acute cervical or high thoracic spinal cord injury admitted to the Canterbury District Health Board's Burwood Spinal Unit and Christchurch Hospital's Department of Intensive Care Medicine (CHDICM) differ. The Burwood Spinal Unit has a delayed approach to nutritional management in contrast to the implementation of early enteral feeding by CHDICM. This prompted a literature review to critically consider the evidence underpinning clinical practice in this field. Literature revealed that nutritional management in the first 72 hours after spinal cord injury is a complex process. The complexities of when to commence, the method of delivering, and the target dose of enteral nutrition in the first 72 hours after spinal cord injury are due to the perceived risk of a spinal ileus and the ensuing, such as adverse effects on abdominal and respiratory function, resulting from enteral feeding intolerance. Literature revealed that delayed nutrition is largely based on expert opinion, while early enteral feeding has limited but stronger scientific research evidence. Nevertheless, it is desirable to use the best evidence currently available to develop, implement and evaluate an evidence-based, protocol driven, clinical pathway for nutritional management of patients within 72 hours of an acute cervical or high thoracic SCI. The author concludes that to ensure an acute spinal cord injury clinical pathway is based on scientific evidence, prospective, multi-centre, randomised controlled trials are needed to substantiate early enteral feeding and identification of the degree of and risk of complications from spinal ileus after acute cervical or high thoracic spinal cord injury.
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