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Fogarty, K. (2005). The assessment of competence in the novice nurse in the adult intensive care unit. Ph.D. thesis, , .
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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Carter, G. E. (2005). Critical thinking abilities: Evidence from students' clinical self-evaluation responses: A pilot study.
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Clarke, R. (2006). New graduate nurse experiences of using health assessment skills in practice: A descriptive qualitative study. Ph.D. thesis, , .
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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Macfarlane, K. (2006). Communicating changes in a patient's condition: A critical incident approach. Ph.D. thesis, , .
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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Neville, S. J., Gillon, D., & Milligan, K. (2006). New Zealand registered nurses' use of physical assessment skills: A pilot study. Vision: A Journal of Nursing, (14(1)).
Abstract: The objective of this project was to ascertain registered nurses' use of selected physical assessment skills before and after participation in a health assessment course. A pre- (also referred to as part I) and post- (part II) test design was used to investigate the research aim. Participants were obtained via a convenience sample. A questionnaire was completed at the beginning of the educational programme and then four to six weeks after completion of the assessment course. A two tailed t-test was used to identify any significant differences in the characteristics of participants from part I (N = 206) to part II (N = 145), with no differences identified. However, there was an overall mean percentage difference of 17.1% in the use of physical assessment skills after having completed the educational programme. In conclusion, the researchers found that four to six weeks after completion of a health assessment course, nurses were using the skills learned to improve their nursing practice more frequently than before the programme.
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Whittle, R. (2007). Decisions, decisions: Factors that influence student selection of final year clinical placements. Ph.D. thesis, , .
Abstract: Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.
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Harris, C., Crozier, I., Smyth, J., Elliot, J., Watson, P. B., Sands, J., et al. (2007). An audit of percutaneous coronary intervention (PCI) patients representing acutely with chest pain within six months of PCI.
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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Turnwald, A. B. (2006). Acute Hypercarbia in Chronic Obstructive Pulmonary Disease (COPD): Presentations to a New Zealand emergency department. Ph.D. thesis, , .
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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Kuehl, S. (2008). Emergency Department re-presentations following intentional self-harm. Ph.D. thesis, , .
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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Ward, V. C. (2013). Preoperative fluid management of the older adult patient with hip fracture. Master's thesis, Victoria University of Wellington, Wellington, NZ. Retrieved June 2, 2024, from http://www.nzno.org.nz/resources/library/theses
Abstract: Explores the relationships between pre-operative fluid management (PFM) and post-operative outcomes. Undertakes an observational study of 100 consecutive older adult patients admitted to a tertiary NZ hospital with traumatic hip fracture between March and Sept 2012. Gathers data regarding cohort demographics and in-hospital events, including surgical details, alongside PFM and post-operative outcomes. Itemises characteristics of the patients, predominantly female with a mean age of 85.2 years. Finds no statistically significant relationship between pre-operative fluid management and post-operative outcomes.
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Moana, B., Crawford, R., & Isaac, D. (2017). Discussing sexual health with older clients: are primary health care nurses sufficiently prepared? Whitireia Nursing and Health Journal, (24), 63–67.
Abstract: Reports some findings of a study which examined primary health care (PHC) nurses' preparedness for engaging older adults in conversation about sexual health research. Examines the experiences and beliefs of PHC nurses working with older clients. Conducts three focus groups with 16 participants who discussed their experiences, values and perceptions of conversations on sexual health with older clients.
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Nakarada-Kordic, I. (2016). Assessing mental models in multidisciplinary operating room teams. Ph.D. thesis, University of Auckland, .
Abstract: Aims to develop a new empirical method for assessing the similarity of mental models in surgery, focusing on laparotomy; to begin the process of validation of the new approach; and to demonstrate how the new approach could be used in clinical practice. Develops a software application (Momento) to sort key tasks in order to capture the information on mental models regarding task sequence and responsibility. Asks 20 6-person operating room (OR) teams, each comprising 3 sub-teams consisting of anaesthesia, surgery and nursing, to complete Momento prior to 2 simulated emergency laparotomies. Suggests the Momento approach could be used to improve teamwork in OR.
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Yip, J. C. Y. (2014). Development of a brief heart healthy eating assessment tool for use by practice nurses in New Zealand. Master's thesis, University of Otago, .
Abstract: Aims to determine how a brief dietary assessment tool should be designed for use by practice nurses in New Zealand with the intention of providing individualised nutrition advice to reduce individuals' risk of cardiovascular disease (heart healthy eating counselling). Recruits 11 practice nurses from the Auckland region for interview and analyses data from the 2008/2009 NZ adult nutrition survey. Uses an action research approach as the underlying strategy of inquiry for the study.
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Sharma, M. (2020). An exploration of the experiences of registered nurses working in aged residential care facilities regarding interRAI: A qualitative research design. Master's thesis, University of Otago, Dunedin. Retrieved June 2, 2024, from http://hdl.handle.net/10523/10009
Abstract: Assesses the experiences of registered nurses (RNs)working in aged residential care facilities in Christchurch, in performing interRAI assessments using interRAI MOMENTUM software. Explores the positive and negative aspects of their experiences and the factors affecting performance of interRAI-based comprehensive health assessments. Identifies the aids and barriers faced by RNs in applying and using interRAI. Conducts focus-group interviews with 7 RNs. Highlights the need for a unified standard assessment system.
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Kussmaul, J. (2020). An investigation of occupational health and safety workplaces and working conditions in comparison to nursing care quality in residential aged care facilities (RACFs) in New Zealand. Doctoral thesis, University of Auckland, Auckland. Retrieved June 2, 2024, from http://hdl.handle.net/2292/50165
Abstract: Identifies critical factors related to the occupational health and safety of workplaces and working conditions in residential aged-care facilities (RACF), from the perspective of nursing staff. Correlates quality indicators for occupational health and safety for workplaces and in working conditions with nursing care quality based on the InterRAI Clinical Assessment Protocols (CAP). Uses a mixed-method approach to conduct an audit of workplace health and safety and environmental conditions in 17 RACFs. Surveys 398 registered nurses (RN), enrolled nurses (EN), and Healthcare Assistants (HCA) about the mental and physical stressors in their work.
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