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Clark, P. N. (2006). The potential for nurse-led clinics on oncology at Southland District Health Board. Ph.D. thesis, , .
Abstract: The author points to a “waiting list crisis” occurring in ambulatory oncology services at Southland District Health Board (SDHB), and notes that the literature suggests this is occurring both nationally and globally. This is due to factors such as an increase in the number of people aged 65 years and over, many of whom will develop cancer. Furthermore new drug therapies and indications for treatment have led to increased numbers of patients referred for oncological assessment in the out-patient clinics. The author notes that, at SDHB, this delay for patients to be seen at a first specialist assessment appointment is causing concern for patients, managers and the medical and nursing staff involved. This dissertation analyses relevant literature in order to explore the nature and outcomes of nurse-led clinics. A range of studies indicate that effective care can be provided by nurses working in a variety of nurse-led clinics settings. These studies reveal ways in which a nurse-led clinic might be established and delivered in oncology services and, the author suggests, this will go some way to provide a solution for SDHB. These clinics would assess and monitor the follow-up of selected patients with stable disease and established care plans such as patients receiving adjuvant chemotherapy for bowel and breast cancer. This would allow medical oncologists to see more new patients at first assessment and the follow-up of complex cases, and could go some way in relieving the current waiting lists. The educational preparation and competency of nurses leading such a clinic are considered.
Keywords: Older people; Scope of practice; Nursing; Oncology; Cancer
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McKergow, C. R. W. (2002). Preparing to care in the 21st century: A personal search for the meaning of ontological competency through an embodied journey of the soul.
Abstract: This thesis is a philosophical inquiry that reflects a personal search for the meaning of ontological competency undertaken by the author after developing breast cancer. The text weaves together in creative synthesis, a collection of academic and personal writing undertaken during an MA (Applied) in Nursing degree process. Using the work of Dowling Singe (1999), Watson (1999), and Wilber (1985, 1990, 1991 & 2000), the thesis seeks, through the use of reflective autobiographical inquiry (Johnstone 1999a), to explore the personal meaning-making activities engaged in during this time to throw light upon the nature of nurse / nursing being. Exploring developmental schemata drawn from personal experience and illuminated by theory, nurses and nursing are challenged to become more self-reflective and self-aware. To facilitate the personal and professional growth that underpins notions of ontological competency, various aids in the form of maps and models are provided to support a transformative journey into awareness. From this position of expanding consciousness, the nurse / nursing is encouraged to reach beyond current paradigms, metaparadigms, epistemologies, and restrictive philosophies and to yield to the evolutionary imperative that seeks to prepare for a 21st century clinical practice where caring / healing becomes embodied enactment from “the Ground of All Being”.
Keywords: Nursing; Professional development; Breast cancer; Cancer
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Southgate, D. (2002). Advocating practice: The role of the community oncology nurse. Ph.D. thesis, , .
Abstract: The primary aim of this research was to advocate for, and make known, the role of the community oncology nurse, and to bring alive the hidden issues of nursing people in the community who have active cancer treatment. This study is also about the author's journey from novice to expert in developing the role as a community oncology nurse. The research also aimed to identify and understand practice that community oncology nurses do and often take for granted. To capture the essence of this study the method of reflective topical autobiography was utilised, which gave the opportunity to gather advanced nursing inquiry, and generate new nursing knowledge. To obtain insight into the highs and lows in everyday interaction with patients, reflective practice stories are presented. The thesis generated by this research is that care required by cancer patients at home goes beyond the scope of traditional community health. It requires nurses to be competent in technological skills as well as bringing in-depth expertise to the practical and human needs of people experiencing cancer. The role involves holistic, family-centered care; anticipating patient and family needs; educating; managing symptoms; advocating; confronting ethical issues; coordinating complex care; and monitoring progress.
Keywords: Community health nursing; Cancer; Nurse-patient relations; Oncology
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James, G. G. (2008). Woven threads: A case study of chemotherapy nursing practice in a rural New Zealand setting. Ph.D. thesis, , .
Abstract: This descriptive case study was undertaken to provide an account of chemotherapy practice in a nurse-led clinic located within a rural New Zealand area. The researcher, an oncology nurse specialist, worked alongside colleagues for thirteen months to enable practice development. This clinic developed out of a need to have services closer to rural patients in order to address issues of equity, access, care integration and the fiscal and social constraints associated with the cancer burden of care. Capturing the range of data applicable to this case; the ability to conceptualise it as a service within its context was possible using case study research methods. Four nurses involved in the chemotherapy clinic were participants in this study. The findings of this study reveal that what could be perceived as barriers to outcomes and practice can in essence be turned into opportunities to develop new ways of caring for the patient and supporting nursing practice. These nurses view their practice as safe within the clinic despite resource constraints. They work in many ways to support each other and to cushion the patient from the impact of situational and contextual influences. Nursing practice was shown to evolve as a direct result of internal and external influences which were the impetus for nurses taking responsibility for their own competency. This study also explored what it meant to be an experienced nurse but novice in a speciality practice. It challenges previously held assumptions that, to deliver chemotherapy successfully, a nurse needs to be operating from a previously held body of oncology nursing knowledge. Many challenges are faced on a day to day basis in a rural practice environment to just maintain consistent care and promote good patient outcomes. The nurses are well aware of their role in contributing to patients' quality of life and the roles they take to meet the growing needs of the patient as a consumer. This study delves into the multifarious nature of this nurse-led clinic and discusses the processes and relationships that are forged to deliver care.
Keywords: Case studies; Rural health services; Nursing specialties; Cancer; Oncology
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Fairhall, M. (2008). An observational study of Peripherally Inserted Central Cather(PICC)-related complications amongst oncology patients. Ph.D. thesis, , .
Abstract: This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days. Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer. These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate.
Keywords: Patient safety; Equipment and Supplies; Nursing specialties; Cancer; Oncology
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Gibson, C. (2005). Hearing the adolescents' voice: A study evaluating the use of conjoint analysis for use with adolescents to determine preferences for inpatient hospital facilities. Ph.D. thesis, , .
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.
Keywords: Adolescents; Hospitals; Patient satisfaction; Cancer
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Corlett, E. (2002). Finding out what works and what doesn't work: Caring for women with a fungating tumour of the breast. Ph.D. thesis, , .
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MacDonald, R. (2005). Mammography screening for breast cancer: Does it reduce the mortality rate? Available online from Eastern Institute of Technology, , 8–12.
Abstract: This paper critically examines the literature on mammography as a breast cancer screening modality. It looks at what the New Zealand consumer is being told about the scientific uncertainties about the effectiveness of mammography and the substantial risks involved with it. This literature review raises concerns about the lack of information available for healthy women to make a fully informed decision about mammography screening.
Keywords: Breast cancer; Screening; Risk management; Health education; Cancer
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Gillespie, M. E. (2013). Compassion fatigue and cancer nurses: a national survey of cancer nurses in New Zealand. Master's thesis, Eastern Institute of Technology, Taradale.
Abstract: Identifies the experiences of NZ cancer nurses whose primary role is to care for patients aged 20 or older, and their whanau/family, and describes the factors that may influence care. Examines whether nurses received training in the management of stressors associated with caring for cancer patients, either during their training or while in the cancer workplace setting. Considers whether nurses working in peripheral (satellite) cancer centres were at more risk than their colleagues in larger regional centres. Conducts a quantitative, descriptive and anonymous survey of members of the Cancer Nurses' Section of the NZNO, using the Professional Quality of Life (ProQOL) questionnaire, which scores compassion fatigue, compassion satisfaction and burnout.
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Kerr, C. (2016). The key components of cancer nurse coordination: an integrative review. (115 p.). University of Canterbury.
Abstract: Backgrounds the creation of the Cancer Nurse Coordinator (CNC) role in NZ. Identifies common key components associated with care-coordination services for cancer patients provided by nurses, and compares these with the NZ Cancer Nurse Coordinator Initiative (CNCI), which was launched in 2013. Undertakes an integrative review of international literature to examine the topic, focusing on the care given to the patient, interactions with health professionals and the system surrounding the patient, and the characteristics surrounding the role of the nurse.
Keywords: Cancer nurses; Nurse specialists; Nurse coordination
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Tewin, M. H. (2015). Exploring the impact of the lung cancer Clinical Nurse Specialist role on patient care in a regional hospital in New Zealand. Master's thesis, University of Otago, .
Abstract: Distributes a questionnaire to 50 members of the multidisciplinary team within a regional lung cancer service to investigate the impact of an advanced nursing role within the team. Performs an audit of five months of clinical data relating to patients cared for by the lung cancer Clinical Nurse Specialist as judged against the MOH Standards of Service Provision for Lung Cancer Patients in New Zealand .
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Frost, C. E. (2020). After mastectomy -- inpatient experience of women in New Zealand: A qualitative study. Master's thesis, University of Otago, Dunedin.
Abstract: Explores the experiences of 10 women post-operatively following mastectomy in an acute surgical ward in a large tertiary hospital in NZ by means of face-to-face, semi-structured, individual interviews. Identifies the women's expectations of care and service delivery from healthcare professionals, in order to inform the development of evidence-based interventions and models of care for the breast cancer care team. Suggests potential areas for future research.
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Matthews, T. M. (2020). Breaking bad news about cancer: The experience of patients, patients' family/whanau members and healthcare professionals. Doctoral thesis, Massey University, Wellington.
Abstract: Explores the subjective experiences of patients, patients' family/whanau members, and health-care professionals (HCP) when bad news was delivered to patients about their cancer within the surgical departments of MidCentral District Health Board. Gathers and compares multiple perspectives and makes recommendations for practice that align with the goals of those involved in the project. Utilises a qualitative approach with the epistemological and methodological basis informed by interpretative phenomenological analysis. Collects data through semi-structured interviews with 10 patients, 6 family members, 5 surgeons and 6 nurses.
Keywords: Cancer nurses; Cancer patients; Diagnosis; Prognosis; Surveys
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Booher, J. (2003). Care of the patient following coronary artery grafts. Available online from the Eastern Institute of Technology website, 10(16), 15–18.
Abstract: This case study outlines the care of Mr. M, a sixty-six year old ventilated patient admitted to an Intensive Care Unit for management following coronary artery grafts. Mr. M's health history and risk factors are explored, in particular how they contributed to his presentation. Mr. M's post operative problems are identified and the rationale for his management is discussed with emphasis on the nursing care provided.
Keywords: Surgery; Nursing; Case studies; Oncology; Cancer
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Ellis, T. (2003). A multidimensional approach to caring for a patient with breast cancer: A case study. Available online from Eastern Institute of Technology, 11(17), 15–19.
Abstract: This story follows the nursing care of a woman in her mid forties, diagnosed with breast cancer. The case study follows her from the diagnosis and decision to undergo a mastectomy, and the requirements of nursing care through that process. It discusses the emotional and physical preparation necessary for surgery, perioperative care, multidisciplinary care, and issues around body image post-mastectomy.
Keywords: Case studies; Breast cancer; Nursing; Cancer; Oncology
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