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Rudd, J. (2005). From triage to treatment: An exploration of patient flow systems in emergency departments. Ph.D. thesis, , .
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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Kingsbury, K. (2000). The illlusion of separateness, a philosophical study of nursing and naturopathic practice: Healing connections between people. Ph.D. thesis, , .
Abstract: This thesis describes the journey of a practicing independent nurse practitioner and naturopath through the stories of five clients. The thesis is presented as a narrative and begins with an account of the events in the practitioner's life that lead to the specific study of natural therapies and the development of a cohesive practice using holistic health practices from a nursing perspective. The text essentially describes the process of establishing a private practice combining two disciplines of nursing and naturopathy in New Zealand. The study reveals how a nurse and naturopath's practice is based on the premise that it is crucial to recognise that the personal life and professional life of the nurse inform and influence each other and are always part of the process of care in such a practice. Three healing modalities that are central to the practice are described in detail. The description is informed by theory and research from nursing, the social sciences and the natural sciences. The study reveals the practical value of postmodern nurse theorists, Jean Watson and Margaret Newman to this practice. This study also briefly discusses the concepts from quantum theory, evolutionary theory and psychoneuroirnmunology that are used in the practice.
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Maries, V. J. (2004). Chosen moments: A reflective journey illustrating terminally ill patients choosing the moment to die.
Abstract: In this project the author reveals how she is observing and thinking as she cares for people who are dying. She records her reflections and insights and reveals that there is life right up to the moment of death, having observed terminally ill patients choosing the precise moment to die. She describes her observations of these moments by using poetry and stories, and explores the implications for her practice as a result. The author presents her reflections using an individualistic, reflective and exploratory perspective which is informed by the work of nursing scholars. This paper is framed using the metaphors of a journey and a window to indicate the reflective process that the author used to journal her observations in practice over time.
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Maher, J. M. (1999). An exploration of the experience of Critical Incident Stress Debriefing on firefighters within a region of the New Zealand Fire Service. Ph.D. thesis, , .
Abstract: This study originates from the author's practice experience working for the New Zealand Fire Service back in the late 1980's and early 1990's as an Occupational Health Nurse where she piloted a Critical Incident Stress Peer Support programme in the No.4 Region. The author identified work-related stress and related it to Critical Incident Stress (CIS) from firefighters exposure to critical incidents. This study explores four firefighters experience of Critical Incident Stress Debriefing (CISD) within a Region of the New Zealand Fire Service. It explores the application of CISD as one component of Critical Incident Stress Management (CISM), and the Nurse Researcher's philosophy of Clinical Nurse practice in relation to the application of CISD. The knowledge gained from the analysis of the data has the potential to influence professionals understanding of their experience and affect future practice and that of others working in the field of CISM. Much of the literature that supported CISD appeared to offer a rather superficial understanding of the firefighters experience in relation to CISD. A narrative approache was chosed as the methodology, utilising four individual case studies as a method of social inquiry in order to explore the experience of CISD. The narratives were able to creatively capture the complexity and the dynamic practice of CISD. An overall pattern of the formalised process was uncovered through the participants' narratives. Eight dominant themes were highlighted from the narratives which included safe environment; ventilating the stress reaction; similar feelings; getting the whole picture; peer support; bonding and resolution. While these themes were common to all the participants, each participant had a particular theme/s which was unique to their experience.
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Watson, S. (2001). Humane caring: Quality of life issues for those elderly people wanting to remain in their own environment. Ph.D. thesis, , .
Abstract: This thesis explores the issues surrounding the elderly remaining in their own environment and why remaining 'at home' becomes so essential for them. There are many elderly people who have moved to residential care settings on the advice of others. The author explores the implications of such moves through the stories of several elderly persons, and her own experiences as a nurse working with the elderly in institutional care.
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Valette, D. (2002). Nursing an adolescent in an adult inpatient mental health unit. Ph.D. thesis, , .
Abstract: This research paper reports on an exploration of the key elements nurses need to be aware of to effectively nurse adolescents in an adult inpatient unit. It describes the developmental needs and significant influences that affect this age-group, that when incorporated into nursing care, nurses can gain a therapeutic relationship with the adolescent. By means of a literature review, sharing the author's experience in nursing adolescents, and through vignettes of practice, an illustration of some common situations that may occur during the adolescent's inpatient stay are described. These situations are explored and a perspective is offered on how nurses may be effective in their nursing of an adolescent patient from the point of admission through to discharge. More research is needed on adolescent mental health nursing, however the author anticipates that nurses will be able to use this report as a helpful resource in their current practice.
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Sims, D. A. (2004). The benefits and challenges of one New Zealand nursing undergraduate clinical education model: A case study. Ph.D. thesis, , .
Abstract: This research project utilised a case study approach to give ward managers a voice in the literature, by exploring and describing from their perspective the benefits and challenges of one particular nursing undergraduate clinical education model. The tertiary education provider contracts the health provider to provide Clinical Nurse Educators (CNEs) to support second and third year undergraduate nursing students during their clinical experiences. The CNEs are seconded from their respective wards to meet the organisation's contractual obligations. Data were gathered from two ward managers using semi-structured interviews. The findings elucidate the role of the undergraduate CNE, highlighting benefits such as the CNE being supernumerary to ward rosters and having time to teach, not only supervise students. CNEs are student-focused and easily accessible as they are based on site. The CNE was the one person who was 'there' for a student as a student's preceptor can change shift-by-shift and day-by-day. One significant challenge which emerged was the replacement of ward staff, not only of senior nurses who can leave their wards for up to 12 weeks to undertake the CNE role but also that of the student's preceptor if the student's preceptor was on annual, sick or study leave. Other challenges such as the inability of ward managers to pre-book casual staff; preceptor work-loads; skill-mix issues and fluctuating fulltime equivalents are also discussed.
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Rochford, N. M. (2004). As a nurse in the family: Three women's stories of what it means for a female nurse to be caregiver to a family member who is ill, elderly or with an enduring illness. Ph.D. thesis, , .
Abstract: In this research, three female registered nurses relived their experiences of being caregiver to a family member who was ill, elderly or had an enduring illness and explored whether they chose, or felt obligated, to assume the role of caregiver because they were nurses. This research was an exploratory descriptive study utilising narrative as inquiry and the method of story-telling. It is women-centered, taking into account the unpaid role of caregiving within families most often fulfilled by women. Four main themes were identified and renamed to highlight research findings – these were the culture of nursing, silence of the nurses, emotional cloudiness, and the natural role of the nurse. Through this study it is hoped that nurses will be more aware of the impact their caregiving roles have had on their lives. The importance in acknowledging the effects of caregiving, relevance of informing employers to promote supportiveness, implications for workforce development and recognising the loss of objectivity in caring when emotions are involved, are identified in this research. The author suggests that further indepth research about these concepts would be a valuable contribution to the nursing profession and ideas for future research have been identified.
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Esera, F. I. (2001). If a client is operating from a Samoan world view how can s/he be holistically and appropriately treated under the western medical model? Ph.D. thesis, , .
Abstract: This paper is an analysis of the cultural and traditional factors that the author presents as essential considerations in the treatment of Samoan people who have been diagnosed with a mental illness. Just as important to any clinical diagnosis, is the spiritual nature of Samoan culture and traditions, which inform belief systems. A full understanding of these will explain how the traditional beliefs and cultural values of Samoan people have an impact on their perception of mental illness, its causes and cures. The thesis places emphasis on 'ma'i -aitu', the Samoan term for most ailments pertaining to the mind or psyche. The focus is on defining 'ma'i -aitu' as part of a Samoan world view and likewise a description of a similar type of manifestation in the Papalagi (western) context of a psychiatric disorder and how treatment and management is usually undertaken. The issues addressed in this paper aim to highlight the Samoan client's world view from a Samoan perspective of mental illness which then poses the question of how they can be managed holistically and appropriately under the Papalagi medical system. Furthermore, it questions if the traditional belief system of Samoans run deeper than originally thought and can the replacement thereof by a foreign culture be responsible for the increased mental problems in Samoans living in New Zealand? This paper emphasises the importance of integrating the western medical model and Samoan health models, for appropriate mental health service delivery to Samoan people.
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Lally, E. J. (2002). An exploration of language and nursing practice to improve communication in the context of ear syringing. Ph.D. thesis, , .
Abstract: This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Action research is a critical reflective process that involves spirals or cycles of planning, acting, reflecting/evaluating and replanning the next cycle. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, the author and another practice nurse co-researched this study during working hours. Twelve people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, the researchers read their own and then each other's transcripts, and listened to the recordings. They discussed and reflected on their findings and planned the next cycle. Throughout the process, the researchers found a number of areas of practice to change or enhance. Changes included the use of technical language such as “contraindications” and “auditory meatus”, the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge, for example when both researchers forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting the researchers agreed to continue the reflective process they had begun to explore their practice.
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Matheson, S. (2002). Psychiatric/mental health nursing: Positioning undergraduate education. Ph.D. thesis, , .
Abstract: In this paper, the critique of the mental health component of comprehensive nursing education and the questions that it raises are explored from historical, structural and ideological perspectives. In order to locate the past and highlight its significance to where psychiatric/mental health nurses find themselves today some of the history of the asylum system and the development of psychiatric nursing in New Zealand within these structures are presented. Ideological changes to the way mental health was thought about, and responded to, have had considerable impact on where psychiatric nurses practiced, how they practised and what they were named. This created the need for a different kind of nurse and has led to changes in the education of nurses. The structural influences on the training and education of nurses are identified through relevant reports and their recommendations and significance in relation to psychiatric/mental health nursing are examined. Issues deriving from the critique of undergraduate psychiatric/mental health nursing education highlight the urgent nature of the crisis and draw out the multiple and competing discourses that inform the education of nurses. In acknowledging that the crisis can be viewed from multiple perspectives the need for responses from multiple levels involving the Nursing Council of New Zealand, the Ministry of Health, the Mental Health Commission and nurses in education and practice are recommended.
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Jull, A. (1999). Oral Pentoxifylline in the treatment of venous leg ulcers: A meta-analysis. Ph.D. thesis, , .
Abstract: The objective of this meta-analysis was to assess the effectiveness of pentoxifylline as an adjunct to compression bandaging in the treatment of venous leg ulcers. The CENTRAL registers of the Cochrane Peripheral Vascular Diseases and Wounds Groups were searched – each register is routinely updated by extensive searches of electronic databases, handsearching of relevant journals and conference proceedings, and contact with product companies and experts in the field. The drug's manufacturer was contacted and the references of review articles and all obtained trials were scrutinised for further citations. Randomised controlled trials published in any language comparing pentoxifylline and compression with placebo in adult participants with venous ulceration were included. Trials must have reported a meaningful objective outcome (rates of healing, proportions healed, time to healing). Details from eligible trials (independently selected by two reviewers) were extracted and summarised by one reviewer. A second reviewer independently verified extracted data. Eleven clinical trials were identified. Five trials compared pentoxifylline with placebo (compression standard therapy). Six trials were excluded. Pentoxifylline and compression was more effective than placebo and compression (RR 1.30, 95% C1 1.10-1.54) and was robust to sensitivity analyses. The greater number of adverse effects (46 reports) occurred in the pentoxifylline group, although this was not significant (RR 1.12, 95% C1 0.77-1.62); 34 percent of adverse effects were gastro-intestinal. Seven of 21 reported withdrawals were for adverse effects. In conclusion, pentoxifylline appears an effective adjunct to compression bandaging in the treatment of venous ulcers. The absence of cost-effectiveness data suggests it not be employed as a routine adjunct, but it could be considered as for those patients not responding to compression therapy alone. The majority of adverse effects are likely to be tolerated by patients.
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Gardner, G., Dunn, S., Carryer, J. B., & Gardner, A. (2006). Competency and capability: Imperative for nurse practitioner education. The author-version of article, available online from Queensland University of Technology ePrints arc, 24(1), 8–14.
Abstract: The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. The research was conducted in all states of Australia where the nurse practitioner is authorised, and in New Zealand. The research was informed by multiple data sources including nurse practitioner programme curricula documents from relevant universities in Australia and New Zealand, interviews with academic convenors of these programmes and interviews with nurse practitioners. Findings include support for masters level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability.
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Gardner, A., Hase, S., Gardner, G., Dunn, S., & Carryer, J. B. (2008). From competence to capability: A study of nurse practitioners in clinical practice. Author copy available 12 months after publication from QUT ePrints, 17(2), 250–258.
Abstract: This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. A secondary analysis of data obtained from the interviews with 15 nurse practitioners working in Australia and New Zealand was undertaken. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. This study suggests dimensions of capability need to be considered in the education and evaluation of nurse practitioners.
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Ramsden, I. (2002). Cultural safety and nursing education in Aotearoa and Te Waipounamu. Ph.D. thesis, , .
Abstract: The research on which this thesis is based involves both a private narrative and a public narrative, with the story of cultural safety, and the history, theory and the future direction gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced cultural safety ideas into nursing and midwifery. Early nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety Theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to education pedagogy and to nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the New Zealand concept of cultural safety is undertaken. The role and application of the Treaty of Waitangi to the theory of cultural safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of cultural safety into the nursing education system and its implementation. The public and media reaction to the inclusion of cultural safety in the national examination for nursing registration and the subsequent parliamentary response are noted. The interviews with nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of cultural safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in nursing and midwifery education. The author notes that the story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, she points out that, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients.
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