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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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McBride-Henry, K., & Foureur, M. (2007). A secondary care nursing perspective on medication administration safety. Journal of Advanced Nursing, 60(1), 58–66.
Abstract: This paper reports on a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, or undermine, safe practice during this process. Data were collected in 2005 using three focus groups of nurses that formed part of a larger study examining organisational safety and medication administration from a nursing perspective. A narrative approach was employed to analyse the transcripts. Participants had good understandings of organisational culture in relation to medication safety and recognised the importance of effective multi-disciplinary teams in maintaining a safe environment for patients. Despite this, they acknowledged that not all systems work well, and offered a variety of ways to improve current medication practices. These findings highlight the meaningful contribution nurses can make to patient safety and emphasise the importance of including the nursing voice in any quality improvement initiatives.
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Giddings, D. L. S., & Grant, B. M. (2007). A Trojan Horse for positivism? A critique of mixed methods research. Advances in Nursing Science, 30(1), 52–60.
Abstract: This paper presents an analysis of mixed methods research, which the authors suggest is captured by a pragmatically inflected form of post-positivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favour the forms of analysis and truth finding associated with positivism. The authors anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, they recognise that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.
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Bland, M. F. (2007). Betwixt and between: A critical ethnography of comfort in New Zealand residential aged care. Journal of Clinical Nursing, 16(5), 937–944.
Abstract: This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents' comfort. A critical ethnographic approach was used and fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination. Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be 'betwixt and between' comfort and discomfort simultaneously. The constraints of one-size-fits-all care delivery practices and the tensions inherent in communal living compounded residents' discomfort. The findings show that individualised care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents.
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Lim, A. G., Honey, M., & Kilpatrick, J. (2007). Framework for teaching pharmacology to prepare graduate nurse for prescribing in New Zealand. Nurse Education in Practice, 7(5), 348–353.
Abstract: The educational framework used to teach pharmacology to nurses by one university in New Zealand is presented, along with early findings on the effectiveness of this approach. Nurse prescribing is relatively new in New Zealand and is related to the expanding roles and opportunities for nurses in health care. Opposition to nurse prescribing in New Zealand has been marked and often this has been linked to concerns over patient safety with the implication that nurses could not be adequately prepared for safe prescribing.
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North, N. (2007). International nurse migration: Impacts on New Zealand. Policy, Politics, & Nursing Practice, 8(3), 220–228.
Abstract: Nurse migration flows in and out of New Zealand are examined to determine impacts and regional contexts. A descriptive statistics method was used to analyse secondary data on nurses added to the register, New Zealand nurse qualifications verified by overseas authorities, nursing workforce data, and census data. It found that international movement of nurses was minimal during the 1990s, but from 2001 a sharp jump in the verification of locally registered nurses by overseas authorities coincided with an equivalent increase in international registered nurses added to the local nursing register. This pattern has been sustained to the present. Movement of local registered nurses to Australia is expedited by the Trans-Tasman Agreement, whereas entry of international registered nurses to New Zealand is facilitated by nursing being an identified “priority occupation”. The author concludes that future research needs to consider health system and nurse workforce contexts and take a regional perspective on migration patterns.
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Lesa, R., & Dixon, D. A. (2007). Physical assessment: Implications for nurse educators and nursing practice. International Nursing Review, 54(2), 166–172.
Abstract: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. Recent implementation of advanced practice roles has expanded the scope of practice and nurse practitioners may now be expected to perform physical assessments. The aim of this literature review was to discover what could be learnt from the experiences of Western countries. Nurses from the USA, Canada and Australia readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing.
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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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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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Latta, L. (2007). Exploring the impact of palliative care education for care assistants employed in residential aged care facilities in Otago, New Zealand. Ph.D. thesis, , .
Abstract: Palliative care is a growing specialty in New Zealand with many well-established hospices and palliative care services around the country. However palliative care is not confined to specialist units and is in fact an element of all health services. The aged care sector is one of those services where patients with palliative care needs are prevalent and this is now beginning to be recognised. In these settings care assistants, most of whom have no training, make up a large component of the workforce providing care for residents with increasingly complex needs. In 2005, Hospice New Zealand responded to the recommendations made by the New Zealand Palliative Care Strategy (Ministry of Health, 2001) by developing an eight-hour palliative care course for care assistants employed in residential aged care facilities. The main objective of the course was to increase care assistants' ability to deliver a high standard of palliative care to their residents within their scope of practice.This qualitative study uses descriptive, semi-structured interviews to explore the impact that attending the course had on care assistants and their practice by inviting them to share stories of their experiences caring for dying residents. Factors influencing the implementation of learning in the workplace were identified. The results showed that while attending the course had a positive impact on participants, they were restricted in the extent to which they were able to apply new learning in the workplace, which was largely due to factors that were out of their control. As a result, recommendations are made to enhance workforce development in the aged care sector and to minimise the barriers to the implementation of learning.
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Mitchell, P. (2007). Grade-1 pressure ulcer: Review of prevention evidence for “at risk” patients in an acute environment. Ph.D. thesis, , .
Abstract: This dissertation is a review of evidence underpinning the recommendations for pressure ulcer prevention from four national guidelines frequently used as a foundation for best practice. The focus is on grade-1 pressure ulcer prevention for “at risk” patients, in the acute environment. Rationale: Prevention is better than cure. While preventive strategies maybe effective are they supported by evidence? Results: The strongest evidence for best practice appears to be limited to an established fact that standard hospital mattresses should at least be replaced by high specification foam, pressure reducing mattresses for patients “at risk” or vulnerable to pressure ulcer development. Repositioning, skin assessment, skin protection and maintenance, traditionally the basis of pressure ulcer prevention, appear to have a paucity of strong supportive evidence. Further evidence is emerging on clinically important areas such as erythema and mattresses. Implications for Nursing: The organisational or ministerial support for education of the multidisciplinary team, especially nurses in risk assessment and prevention strategies. This support is required both in release time and finances for education and in adequate funding for preventive strategies. The author concludes that strong evidence to support the recommendations of the guidelines appears to remain limited, particularly in the acute environment. Expert opinion would appear to remain the basis for current best practice for pressure ulcer prevention. The volume and consistency of this evidence worldwide is substantial and adds validity to the recommendations. Best practice includes firstly risk assessment, skin assessment, maintenance of skin temperature, moisture, and condition, and the importance of repositioning, in conjunction with an appropriate support surface. However gaps remain in the supportive evidence in many of these fields. Advances in practice include pressure relief or reduction considerations for all surfaces the patients encounter. There appears to be no gold standard for prevention of pressure ulcer development.
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Leeks, O. (2007). Lesbian health: Identifying the barriers to health care. Ph.D. thesis, , .
Abstract: Homosexuality has been practiced since ancient times, but through the centuries this expression of sexual identity has moved from being acceptable to unacceptable and finally regarded in a contemporary era as a mental health problem that needed to be, and it was thought could be, cured. This paper focuses on the barriers that lesbian women perceive when wanting to access health care. Most of the research about lesbian women has been conducted in the United States with some in the United Kingdom, Canada and New Zealand. Through reviewing the available literature and grouping common themes, the author identifies three main barriers to health care that exist for lesbian women. Firstly, ignorance or insensitivity of the health care professional about the specific health care needs of this client group; secondly, homophobia or heterosexism that may be present in the health care environment; and thirdly the risk of disclosing one's sexual orientation. These barriers are discussed using the concepts of cultural safety and nursing partnership. The author concludes that the negative health care experiences that lesbian women encounter leave them feeling vulnerable and fearful. This fear and stigmatisation has resulted in lesbian women becoming an 'invisible' community. It is the assumption of heterosexuality that immediately places the lesbian woman at a disadvantage and this potentially may produce missed opportunities to provide individualised care to the lesbian client. The purpose of this work is to encourage discussion within nursing to challenge attitudes and the approach to women who identify as lesbian. The author hopes that this paper will contribute to the increasing body of knowledge in regard to this client group.
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McGirr, S. (2007). New graduate nurses clinical decision making: A methodological challenge. Ph.D. thesis, , .
Abstract: New graduate nurses, particularly in the first year of clinical practice, face challenges with making clinical decisions about patient care. A review of the literature revealed no studies that reported using fundamental qualitative descriptive methodology to investigate new graduate nurses' clinical decision making. Aspects of decision making by new graduates have been studied using observational and interview methods, the findings from which have been interpreted using various theoretical decision making models. There has been little research outside of the context of critical care or intensive care units, but anecdotal reports in 2006 from the New Zealand Nursing Entry to Practice Programme (NetP) coordinators network suggest that new graduates are seldom employed in critical care or intensive care units in New Zealand. Nursing educators involved in undergraduate nurse training and NetP programmes need to understand how new graduates perceive, experience and manage decision making in clinical practice, in order to assist them to develop and refine those skills. There is a need for studies utilising fundamental qualitative descriptive methodology in order to explore the experiences of new graduates' decision making in clinical practice. The author notes that the topic is particularly relevant in light of the introduction of the national NetP programmes framework in New Zealand, and to her role as a NetP programme coordinator. This dissertation examines the relevant literature about decision making by new graduates and the research methods that were used, and concludes that fundamental qualitative descriptive method is a highly appropriate method by which to study new graduates' decision making.
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