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Author |
Kuehl, S. |
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Title |
Emergency Department re-presentations following intentional self-harm |
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Year |
2008 |
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; Psychiatric Nursing; Mental health; Clinical assessment |
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Abstract |
The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1214 |
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Author |
Turnwald, A.B. |
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Title |
Acute Hypercarbia in Chronic Obstructive Pulmonary Disease (COPD): Presentations to a New Zealand emergency department |
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Year |
2006 |
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 |
Chronically ill; Clinical assessment; Emergency nursing |
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Abstract |
A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1210 |
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Author |
Pitama, S.; Robertson, P.; Cram, F.; Gillies, M.; Huria, T.; Dalla-Katoa, W. |
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Title |
Meihana model: A clinical assessment framework |
Type |
Journal Article |
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Year |
2007 |
Publication |
New Zealand Journal of Psychology |
Abbreviated Journal |
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Volume |
36 |
Issue |
3 |
Pages |
118-125 |
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Keywords |
Nursing models; Clinical assessment; Maori; Mental health |
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Abstract |
In 1984 Mason Durie documented a framework for understanding Maori health, Te Whare Tapa Wha, which has subsequently become embedded in Maori health policy. This article presents a specific assessment framework, the Meihana Model, which encompasses the four original cornerstones of Te Whare Tapa Wha, and inserts two additional elements. These form a practice model (alongside Maori beliefs, values and experiences) to guide clinical assessment and intervention with Maori clients and whanau accessing mental health services. This paper outlines the rationale for and background of the Meihana Model and then describes each dimension: whanau, wairua, tinana, hinengaro, taiao and iwi katoa. The model provides a basis for a more comprehensive assessment of clients/whanau to underpin appropriate treatment decisions. |
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Call Number |
NRSNZNO @ research @ |
Serial |
459 |
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Author |
Fogarty, K. |
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Title |
The assessment of competence in the novice nurse in the adult intensive care unit |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Issue |
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Pages |
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Keywords |
Intensive care nursing; Nursing specialties; Clinical assessment |
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Abstract |
This dissertation explores the assessment of nurses' clinical competence in the adult ICU setting. Specifically, methods for the assessment of competence are critiqued for their practical application to the novice nurse with less than six months experience in ICU. The assessment methods considered are continuous clinical assessment, self-assessment, peer review, objective structured clinical examination (OSCE), portfolio and computer assisted assessment. Several criteria are applied to the methods including the ability of each method to assess skills, knowledge and attitudes or values. Each method is critiqued for its implications in terms of cost and staffing resource, benefits and barriers to implementation. In addition, reliability and validity issues are considered for each method. The outcome of this exploration is the recommendation of a combination of methods; namely, portfolio and OSCE, for the assessment of competence in the ICU novice. The author concludes that this finding enhances current understanding within the ICU specialty of the multidimensional nature of competence assessment. |
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Call Number |
NRSNZNO @ research @ |
Serial |
574 |
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Author |
Clarke, R. |
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Title |
New graduate nurse experiences of using health assessment skills in practice: A descriptive qualitative study |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
New graduate nurses; Clinical assessment |
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Abstract |
Use of health assessment skills is undeniably part of everyday nursing practice, guiding nursing decisions and a part of facilitating patient outcomes. Undergraduate nursing education in New Zealand includes the use of health assessment skills within the context of nursing practice. The registered nurse working in their first year of practice is required to use effective assessment skills to identify potential risks to a patient's health, while learning to adjust to the many other demands of practice, but little research has explored these experiences. The purpose of this research study was to describe the experience of using health assessment skills within the first year of practice as a registered nurse. Using a qualitative descriptive method, informed by phenomenology, interviews were conducted with six newly graduated registered nurses working within a New Zealand setting. Findings of this study revealed that graduates endeavour to incorporate the skills of health assessment taught at undergraduate level into their practice. Six main themes of health assessment philosophy; tuning in; mobilising health assessment skills; recognition; anxiety; and identification and facilitation of outcomes can be aligned with Benner's (1984) model of skill acquisition. The author suggests that these research findings are useful to inform nursing education, clinical practice and further research. An awareness of these graduate experiences provides opportunities for nurses in both clinical practice and education to facilitate and support graduate nurses' of health assessment within their nursing practice. |
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Call Number |
NRSNZNO @ research @ |
Serial |
682 |
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Author |
Hamer, H.P.; McCallin, A. |
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Title |
Cardiac pain or panic disorder? Managing uncertainty in the emergency department |
Type |
Journal Article |
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Year |
2006 |
Publication |
Nursing & Health Sciences |
Abbreviated Journal |
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Volume |
8 |
Issue |
4 |
Pages |
224-230 |
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Keywords |
Emergency nursing; Clinical assessment; Diagnosis |
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Abstract |
This paper presents research findings from a New Zealand study that explored emergency nurses' differentiation of non-cardiac chest pain from panic disorder and raised significant issues in the nursing assessment and management of such clients. The data were gathered from focus group interviews and were analysed thematically. Three themes, prioritising time, managing uncertainty and ambiguity, and the life-threatening lens, were identified. The findings confirm that a panic disorder is not always diagnosed when biomedical assessment is used in isolation from a psychosocial assessment. Emergency nurses are pivotal in reversing the cycle of repeat presenters with non-cardiac chest pain. Recommendations for assessing and managing this complex condition are presented. |
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Call Number |
NRSNZNO @ research @ |
Serial |
689 |
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Author |
Macfarlane, K. |
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Title |
Communicating changes in a patient's condition: A critical incident approach |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Communication; Clinical assessment; Physicians; Nursing; Relationships |
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Abstract |
This study explores how registered nurses working within the acute surgical ward environment of a New Zealand hospital communicate changes in a patient's condition. The purpose of this research study was to examine the processes, communication techniques and behaviours that nurses use, in order to determine the critical requirements for registered nurses to effectively communicate changes in patients' conditions to doctors. The critical incident technique developed by Flanagan (1954) was adapted and used to explore incidents that occurred when six registered nurses working in acute surgical wards communicated a change in a patient's condition to a doctor. Communication is an integral part of everyday activity. This study has shown an assessment process occurs before communication can take place. A nurse's concern for a patient's condition initiates the assessment process. A judgement is formed from the nurse's concern that a patient's condition has changed. Judgements take into account multiple ways of knowing including pattern recognition, empirical knowing and intuition. Institutional protocols also affect judgements and the ability of a nurse to ensure support is received for the patient's well being. The communication process is initiated for two reasons, to support the patient, and to support the nurse in providing care for the patient. Significant in determining the need for support is the action required that might be outside the nurse's scope of practice. The response should address the nurse's concern and take into account the importance of the relationship, trust between all parties, respect of each other's positions and knowing team members and their capabilities. Understanding these aspects of the communication process should enhance nurses and doctors abilities to effectively communicate regarding a change in a patient's condition. |
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Call Number |
NRSNZNO @ research @ |
Serial |
724 |
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Author |
Lesa, R.; Dixon, D.A. |
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Title |
Physical assessment: Implications for nurse educators and nursing practice |
Type |
Journal Article |
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Year |
2007 |
Publication |
International Nursing Review |
Abbreviated Journal |
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Volume |
54 |
Issue |
2 |
Pages |
166-172 |
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Keywords |
Advanced nursing practice; Clinical assessment; Cardiovascular diseases; Nursing; Education |
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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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Call Number |
NRSNZNO @ research @ |
Serial |
786 |
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Author |
Holloway, K. T. |
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Title |
The future for nursing education: UKCC review has relevance for New Zealand |
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Journal Article |
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Year |
2000 |
Publication |
Nursing Praxis in New Zealand |
Abbreviated Journal |
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Volume |
16 |
Issue |
2 |
Pages |
17-24 |
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Keywords |
Nursing; Education; Recruitment and retention; Clinical assessment; Policy |
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Abstract |
The author reviews the report 'Fitness for Practice' by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) noting many areas of relevance for New Zealand educators in outlining possible strategies for nursing education. Discussion of some of the recommendations is put in the context of a strategic review of undergraduate nursing education recently commissioned by the Nursing Council of New Zealand. Issues such as recruitment and access to education; retention; clinical assessment and placements; clinical skill acquisition and partnership are valid concerns for educators here also. Internationally, the author suggests, the commonalties in issues of concern lend validity to the concept of the global village and the necessity for a global perspective in health care workforce planning, including educational preparation. |
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Call Number |
NRSNZNO @ research @ |
Serial |
848 |
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Author |
Macfie, B. |
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Title |
Assessing health needs and identifying risk factors |
Type |
Journal Article |
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Year |
2006 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
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Volume |
12 |
Issue |
6 |
Pages |
16-18 |
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Keywords |
Infants; Parents and caregivers; Clinical assessment; Risk factors; Plunket |
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Abstract |
In 2004, Plunket nurses from eight areas around New Zealand participated in collecting data for a research project on health needs assessment practices. This project aimed to examine risk factors identified by Plunket nurses, what areas of health need considered to be priorities; grading of health needs; and how closely the results of health need assessment aligned with the individual clients' deprivation score. The researchers examine the assessment of health needs against the use of the Deprivation Index, which indicates a specific population in a specific area, as a funding model. This study appeared to show there are two distinct groups of clients assessed as high needs: those with risk factors such as family violence and severe parental mental illness, and who may live in an area of 1-7 deprivation; and those with multiple risk factors which include poverty, low education, and/or reluctance to access services and support, and who usually live in dep 8-10 areas. This research supports the anecdotal evidence that significant health needs exist outside the lower deprivation areas. |
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Call Number |
NRSNZNO @ research @ |
Serial |
974 |
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Author |
Neville, S.J.; Gilmour, J.A. |
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Title |
Differentiating between delirium and dementia |
Type |
Journal Article |
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Year |
2007 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
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Volume |
13 |
Issue |
9 |
Pages |
22-25 |
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Keywords |
Dementia; Psychiatric Nursing; Clinical assessment; Older people |
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Abstract |
Accurate nursing assessment is a critical element in the identification of health problems and treatment strategies for older adults who have delirium and/or dementia. This practice update provides information on the differentiation between these two debilitating and adverse health events, along with some useful assessment frameworks and other resources. Comments from people with delirium and dementia are interspersed throughout the article to draw attention to the impact of these conditions on people's lives and well-being. The article includes the 'A presenting concern framework', useful mnemonic devices to help nurses assess an older person who may have delirium or dementia, and a list of online resources. |
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Call Number |
NRSNZNO @ research @ |
Serial |
983 |
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Author |
Hardy, D.J.; O'Brien, A.P.; Gaskin, C.J.; O'Brien, A.J.; Morrison-Ngatai, E.; Skews, G.; Ryan, T.; McNulty, N. |
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Title |
Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand |
Type |
Journal Article |
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Year |
2004 |
Publication |
Journal of Advanced Nursing |
Abbreviated Journal |
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Volume |
46 |
Issue |
1 |
Pages |
95-109 |
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Keywords |
Clinical assessment; Biculturalism; Professional competence; Psychiatric Nursing; Maori |
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Abstract |
The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarised responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark. The authors conclude that when rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritising experts' judgements. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1060 |
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Author |
Harris, C.; Crozier, I.; Smyth, J.; Elliot, J.; Watson, P.B.; Sands, J.; Cuddihy, R. |
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Title |
An audit of percutaneous coronary intervention (PCI) patients representing acutely with chest pain within six months of PCI |
Type |
Manuscript |
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Year |
2007 |
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 |
Hospitals; Clinical assessment; Cardiovascular diseases; Guidelines; Teaching methods |
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Abstract |
This reports an audit of the assessment practices at Christchurch Hospital, compared to international guidelines. The clinical notes of all patients who were re- admitted acutely with chest pain within six months of PCI procedures performed between 1/4/05 and 30/9/05 were audited. Ethics approval was granted and an audit tool was designed based on the 2000 ACC/AHA Guidelines for the management of patients with unstable angina. The purpose of the audit was to determine to what extent best practice guidelines were followed in the assessment of patients re-admitted with chest pain and to determine if there were any indicators (lesional, procedural or risk factors for restenosis) that predicted a normal or abnormal repeat coronary angiogram. 448 consecutive patients had PCI procedures, 36 patients represented acutely with chest pain and had repeat coronary angiography. In 18 patients the coronary angiogram was unchanged, 11 patients demonstrated instent restenosis, one patient demonstrated thrombus and six patients developed new lesions. The authors concluded that at Christchurch Hospital assessment practices are consistent with international guidelines. Of the patients who had repeat angiography, 50% had no coronary obstruction for the cause of pain. There was a relatively low incidence of acute representation with chest pain. These results suggest a revision of the guidelines for repeat angiography following PCI is warranted. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1157 |
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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 |
Mahoney, Laurie |
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Title |
Children living with a mentally ill parent : the role of public health nurses |
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Journal Article |
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Year |
2010 |
Publication |
Nursing Praxis in New Zealand |
Abbreviated Journal |
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Volume |
26 |
Issue |
2 |
Pages |
4-13 |
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Keywords |
Public health nurses; Parental mental illness; Advocacy; Assessment; Focus group |
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Abstract |
Aims to identify the public health nurses' role with regard to children who are living with a parent who is suffering from a mental illness. Uses a qualitative research design with 8 public health nurses working in rural and urban settings. Conducts focus groups from which data are gathered and analysed thematically using axial coding. Conducts further focus groups with 6 of the participants to evaluate the themes identified. |
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Call Number |
NZNO @ research @ |
Serial |
1454 |
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