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Author |
McCloskey, B.A.; Diers, D. |
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Title |
Effects of New Zealand's health reengineering on nursing and patient outcomes |
Type |
Journal Article |
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Year |
2005 |
Publication |
Medical Care |
Abbreviated Journal |
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Volume |
43 |
Issue |
11 |
Pages |
1140-1146 |
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Keywords |
Patient safety; Organisational change; Nursing; Hospitals |
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Abstract |
This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1052 |
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Author |
Cobham, J. |
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Title |
Why do nurses stay in nursing? A test of social identity, equity sensitivity and expectancy theory |
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Year |
2005 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing; Recruitment and retention; Identity |
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Abstract |
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Call Number |
NRSNZNO @ research @ |
Serial |
1107 |
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Author |
Scrymgeour, G. |
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Title |
Using diagnostic reasoning in nursing practice: Ectopic pregnancy: A case study approach |
Type |
Journal Article |
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Year |
2005 |
Publication |
Vision: A Journal of Nursing |
Abbreviated Journal |
Available online at Eastern Institute of Technology |
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Volume |
13 |
Issue |
1 |
Pages |
13-17 |
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Keywords |
Nursing; Pregnancy; Clinical assessment |
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Abstract |
This paper explores, through the use of a case study, an evidence-based diagnostic reasoning process utilising the framework followed by Dains, Baumann and Scheibel (1998). This framework, as described by these authors, involves an inductive process of reasoning, which leads to formulation of a hypothesis that is then analysed using an evidence-based approach. From this analysis, a likely diagnosis can be made and appropriate therapeutic intervention initiated. This research demonstrates that although an evidence-based approach is the ideal, sometimes clinical intuition is equally important to the clinical outcome. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1305 |
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Author |
Vandergoot, A. |
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Title |
From ward nurse to proficient critical care nurse: a narrative inquiry study |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Held by Lakes DHB Library (ROM) |
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Issue |
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Pages |
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Abstract |
A dissertation [thesis] presented in partial fulfillment of the degree of Master of Health Science. |
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Call Number |
NZNO @ research @ |
Serial |
1367 |
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Author |
Cleaver, H |
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Title |
Reflections on knowing, not knowing and being in palliative care nursing |
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Year |
2005 |
Publication |
A research paper submitted to the Victoria University of Wellington in partial fulfilment of the requirements for the degree of Master of Arts (Applied) in nursing |
Abbreviated Journal |
Victoria University of Wellington |
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Volume |
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Issue |
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Pages |
57 |
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Keywords |
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Abstract |
Responses to questions from dying people and their families are as individual as each nurse, patient, family member or situation. This is well recognised and an unspoken truth in palliative care practice
This paper explores the subjective nature of knowledge in palliative care generated through capturing moments of practice and subsequent reflections. This demonstrates how the author uses her model of care to open a space that enables the person and their family to find meaning from their experience and articulate what they need at the time.
The author identifies her interest in the paradoxical reality of knowing and not knowing and describes how that paradox contributes to her role in supporting individual?s needs within their realities |
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Call Number |
NZNO @ research @ |
Serial |
1378 |
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Author |
Moore, Justin |
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Title |
Breaking down barriers in child healthcare (0-5) years. Margaret May Blackwell Travelling Fellowship 2005 |
Type |
Report |
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Year |
2005 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
29 |
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Keywords |
Child health services; Children's Hospitals; Emergency Departments; Drugs; Reports |
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Abstract |
Travels to Australia, Canada, the US and the UK to investigate various methods of procedural sedation for 0-5-year-olds in paediatric Emergency Departments. Describes the types of sedation used and the recovery periods. Transcribes the interviews he conducted with Emergency Department staff in each country. Part of the Margaret May Blackwell Scholarship Reports series. |
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Call Number |
NZNO @ research @ |
Serial |
1427 |
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Author |
Gabolinscy, B. |
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Title |
Triage codes: A predictor of nursing care time in the emergency department |
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Year |
2005 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing; Time factors |
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Abstract |
This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%). The author suggests that further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments. |
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Call Number |
NRSNZNO @ research @ 481 |
Serial |
468 |
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Author |
Rudd, J. |
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Title |
From triage to treatment: An exploration of patient flow systems in emergency departments |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing; Hospitals; Risk management; Patient safety |
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Abstract |
To find an effective approach to managing or reducing waiting times for lower triage category patients processed through one particular metropolitan emergency department, an extensive search of the literature revealed several different patient flow processes. These approaches are discussed, in relation to suitability for the particular emergency department. The history of triage, including how and why it evolved, plus the realities of triage today are explored. Included are case examples of two patients on a journey through the department the way it is presently, and how it could be if particular approaches are introduced. Extending nursing practice by introducing nurse-initiated x-rays at triage and the introduction of a separate stream for minor category patients in a dedicated ambulatory care area is one approach that could improve waiting times for these patients. There would be the added advantage of improving triage compliance figures for category three patients. The additional costs involved in such a process could be offset by improved efficiency in terms of waiting times, improved triage compliance figures, happier patients and clinical staff, and an emptier waiting room. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1209 |
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Author |
Mosley, B. |
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Title |
Seclusion management in an acute in-patient unit |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Psychiatric Nursing; Patient rights; Hospitals; Workplace violence |
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Abstract |
This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. It also includes the author's personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses' way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person's level of acuity and to their ability to engage in this approach in a tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person. |
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Call Number |
NRSNZNO @ research @ 1227 |
Serial |
1212 |
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Author |
Lake, S.E. |
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Title |
Nursing prioritisation of the patient need for care: Tacit knowledge of clinical decision making in nursing |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Clinical decision making; Nursing |
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Abstract |
Effective nursing prioritisation of the patient need for care is integral to daily nursing practice but there is no formal acknowledgement or study of this concept. Utilising the retroductive research strategy of critical realism, this thesis explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. The tacit knowledge discerned within the literature indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Such nursing prioritisation takes place concurrently between the competing or even conflicting needs of the several individual patient presentations within the nurse's caseload. Varied frames of reference within different practice settings create specific imperatives on this dynamic and non-sequential process. Starting with an initial set of studies in the 1960s, study of clinical decision-making in nursing has created a significant body of knowledge encompassing a range of approaches. Nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain language descriptions of nurse decision-making. Within the selected literature it is apparent that nursing prioritisation of the patient need for care is an advanced skill of nursing that is developed in practice and honed through experiential learning. |
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Call Number |
NRSNZNO @ research @ |
Serial |
661 |
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Author |
Lake, Sarah Elizabeth |
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Title |
Nursing Prioritisation of the Patient Need for Care:Tacit Knowledge of Clinical Decision Making in Nursing |
Type |
Book Whole |
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Year |
2005 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
193 p. |
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Keywords |
Clinical decision-making; Patients; Prioritisation; Need for care |
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Abstract |
Explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. Indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Examines the body of knowledge pertaining to clinical decision-making in nursing, suggesting that nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain-language descriptions of nurse decision-making. |
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Call Number |
NZNO @ research @ |
Serial |
1531 |
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Author |
Thompson, C.M.M. |
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Title |
Caring for people with mental health problems who present at the emergency department: A nurse educator's journey |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Mental health; Emergency nursing; Education |
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Abstract |
The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem. |
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Call Number |
NRSNZNO @ research @ |
Serial |
575 |
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Author |
Smart, S. |
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Title |
Post-operative pain management knowledge and attitude of paediatric nurses: A New Zealand regional view |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Pain management; Paediatric nursing; Hospitals; Pharmacology |
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Abstract |
This research explored the knowledge and attitudes towards paediatric post-operative pain, within the New Zealand context of small regional hospitals. It established how nurses working in these areas obtain and update their paediatric pain management knowledge, and what is it that influences their paediatric post-operative pain management practices. A questionnaire survey of registered nurses working in three small paediatric units (5 to 12 beds), in regional secondary service hospitals was undertaken. The survey had a 79% (n=33) response rate. Findings corroborate many findings in previously published literature including that nurses do well in questions related to assessment. However pharmacological knowledge continues to be lacking. Results also indicated that while nurses have a good understanding about who is the best person to rate pain, this wasn't carried through in the clinical scenarios provided. Education is clearly an important factor in improving the knowledge and attitudes needed in clinical practice. While this survey was somewhat limited, both in size and in that a clear correlation between the results and actual clinical practice could not be made, results are significant for the areas surveyed and for the development of pain education for nurses. |
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Call Number |
NRSNZNO @ research @ 1194 |
Serial |
1179 |
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Author |
Gibson, C. |
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Title |
Hearing the adolescents' voice: A study evaluating the use of conjoint analysis for use with adolescents to determine preferences for inpatient hospital facilities |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Adolescents; Hospitals; Patient satisfaction; Cancer |
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Abstract |
This research used the economic technique of conjoint analysis and an informal discussion to canvas opinions regarding ideal combination of inpatient facilities and the use of cell phones in hospital. The content of the conjoint analysis was, with the exception of the inclusion of the question regarding the use of cell phones, derived from the literature. Because conjoint analysis does not appear to have been used with adolescents one of the questions to be answered was whether this was a method of research that could be used with adolescents. The research was undertaken with 29 young people, most of who were from CanTeen (the adolescent cancer support group) in Wellington. The conjoint analysis, and discussion with the adolescents supported the general findings from the literature that adolescents do not want to be nursed in either overtly paediatric or, in their words, 'dull adult wards', as they enjoy bright lively surrounds. Ideally they would like to be nursed with their peer group and so have the opportunity to interact with young people of their age. The research demonstrated that adolescents are able to understand the concept of conjoint analysis and also supported findings from overseas that these healthcare consumers value having their opinions canvassed and are well able to give constructive and well thought out opinions. A report on the findings of this research will be presented to Capital and Coast District Health Board with the expectation that it will be considered when the final decisions are made regarding the upgrading of Wellington Hospital's present facilities as it is anticipated that these facilities will contain dedicated adolescent beds within the paediatric unit. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1225 |
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Author |
Lewis, T. |
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Title |
Euthanasia: A Foucauldian analysis |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ScholarlyCommons@AUT |
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Volume |
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Issue |
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Pages |
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Keywords |
Law and legislation; Euthanasia; Ethics; Pain management; Terminal care; Nursing; Palliative care |
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Abstract |
This study drew upon the theoretical insights of Michel Foucault to provide a discursive analysis of the term euthanasia, and the issues surrounding the “right-to-die”. It involved an analysis of primary texts from; nursing, general, and legal literature as well as the media between the years 2002-2004. Drawing upon data researched, the study analyses the main discourses regarding the practice of euthanasia for terminally ill individuals. The two competing discourses that emerged were what the author termed the sanctity-of life-discourse and the right-to-die discourse. The aim of the study was to uncover the discourses understanding of “truth” regarding the right-to-die. The analysis revealed that a small percentage of cancer sufferers (5%) die with their pain insufficiently treated and the right-to-die discourse claims that no individual should have to suffer needlessly, asserting the individuals right to autonomy. Directly opposing this is the sanctity-of life-discourse which states all life is sacred and nothing can justify euthanasia as an acceptable practice in society. These findings indicate the need for effective palliative care and pain management when caring for the terminally ill individual. The legal, ethical and moral implications of euthanasia are many and this study discusses the effects these may have on health professionals involved with the care of terminally ill patients. The study revealed an increasing deployment of the right-to-die discourse in the media and revealed concerns regarding the nursing profession's lack of preparation to deal with euthanasia if it becomes a legal option in end of life care. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1226 |
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