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Farrell, E. (2003). A lamp to light the way: Public health nurses' perceptions and experiences of professional/clinical supervision. Ph.D. thesis, , .
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Williams, J. L. (2003). The Cummins model: An adaption to assist foreign nursing students in New Zealand. Ph.D. thesis, , .
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Grayson, S. (2001). Nursing management of the rheumatic fever secondary prophylaxis programme. Ph.D. thesis, , .
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Clendon, J. (1999). The Nurse Practitioner-led Primary Health Care Clinic; A Community Needs Analysis. Ph.D. thesis, , .
Abstract: Aim: To determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as an alternate or complementary way of addressing the health needs of 'at risk' children and families to the services already provided by the public health nurse.Method: Utilising needs analysis method, data was collected from three sources – known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the public health nurse in order to determine if a public health nurse would be the most appropriate person to lead a primary health care clinic, and the practicalities of establishing a clinic including services participants would expect a clinic to provide. Analysis was descriptive and exploratory.Results: A wide range of health needs were identified from both the demographic data and from participant interviews. Findings also showed that participant's understanding of the role of the public health nurse was not great and that community expectations were such that for a public health nurse to lead a primary health care clinic further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed model that would serve to address the health needs of children and families in the area the study was undertaken.Conclusion: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment is feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required. It is likely that a similar model would also be successful in other communities in New Zealand, however the health needs identified in this study are specific to the community studied. Further community needs assessments would need to be completed to ensure health services target health needs specific to the communities involved.
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Spence, D. (1999). Prejudice, paradox and possibility.
Abstract: This study explores the the experience of nursing a person, or people, form cultures other than one's own. Informed by the tradition of philosophical hermeneutics, and drawing specifically on some of the notions articulated by Hans-Georg Gadamer and Charles Taylor, it seeks to understand everyday nursing practices within their cultural and historical context.Against a background of Maori resurgence, nurses in New Zealand have been challenged in Aotearoa-New Zealand to recognise and address racism in their practice. Meeting the health needs of all people has long been important in nursing yet the curricular changes implemented in the early 1990s to enhance nursing's contribution to a more equitable health service created uncertainty and tension both within nursing, and between nursing and the wider community.In this study, I have interpreted the experiences of seventeen nurses practising in an increasingly ethnically diverse region. Personal understandings and those from relevant literature have been used to illuminate further the nature of cross-cultural experience from a nurse's perspective. The thesis asserts that the notions of prejudice, paradox and possibility can be used to describe the experience of nursing a person from another culture. Prejudice refers to the prior understandings that influence nursing action in both a positive and a negative sense. Paradox relates to the coexistence and necessary interplay of contradictory meanings and positions, while possibility points to the potential for new understandings to surface from the fusion of past with present, and between different interpretations. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, the play of prejudice, paradox and possibility is evident at intra-personal and interpersonal levels as well as in relation to professional and other social discourses. This thesis challenges nurses to persist in working with the tensions inherent in cross-cultural practice. It encourages continuation of their efforts to understand and move beyond the prejudices that otherwise preclude the exploration of new possibilities.
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Williams, H., Cuthbertson, S., Newby, L., & Streat, S. J. (1998). A follow-up service improves bereavement care in an intensive care unit. Ph.D. thesis, , .
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McManus, L. M., Cuthbertson, S., & Streat, S. J. (1998). When the lights went out in Auckland. Ph.D. thesis, , .
Abstract: As the clinical consequences of power failure in intensive care are seldom documented we reviewed the effects of a power failure on patient care, outcomes and the adequacy of our disaster plan. We reviewed clinical records of all ten patients in our department during a 20-minute total hospital power failure, determined the impact of the failure on the therapies being given, and the costs of failed equipment. We assessed the departments disaster plan and identified the causes of the power failure.Nine patients were intubated; six ventilated (one receiving nitric oxide) and three receiving continuous positive airway pressure. Two patients were ventilated by Servo 300,? which continued on batteries, the other four patients were ventilated manually. Six patients were receiving nine inotrope infusions through IMED Gemini,? (battery life 30 minutes). One patient was receiving high volume ultrafiltration using a Gambro? haemodialysis system, which failed. Blood flow to prevent clotting was maintained by turning the roller pump manually. All networked monitoring (SpaceLabs?) failed and three haemodynamically unstable patients were monitored by transport monitors (SpaceLabs Scout?). No patient suffered any ill effect. Failed electronic circuits cost $NZ11,724. The disaster plan was implemented and functioned well. The aged cables supplying Auckland Central failed during an El Nino summer. The hospital generators, supplying power to the city grid, failed to switch over to the hospital. During power failure infusion pumps should be only for inotropes. We now have external 12-volt battery backup. With good pre-planning, safe intensive care continued during a short power failure
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Caldwell, S. (1998). From “beloved imbecile” to critical thinker: producing the politicized nurse. Ph.D. thesis, , .
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Abel, S. (1997). Midwifery and maternity services in transition: an examination of change following the Nurses Amendment Act 1990. Ph.D. thesis, , .
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Margetts, M., Cuthbertson, S., & Streat, S. J. (1996). Bereavement follow-up – its impact on practice. Ph.D. thesis, , .
Abstract: Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care
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Pearce, L., Cuthbertson, S., Streat, S. J., & Hay, D. (1996). Dental hygiene in the critically ill: a randomised controlled trial of three methods. Ph.D. thesis, , .
Abstract: Introduction Critically ill patients cannot clean their own teeth. A variety of methods are used but as the best method is unknown we performed a prospective randomised double-blind controlled trial of three methods.Method Of 359 consecutive admissions to the Department of Critical Care Medicine between 31/01/97 and 25/05/97, 222 were excluded (62 edentulous, 6 unexaminable, 142 transferred alive and 12 dead or dying at 24 hours). The remaining 137 patients had quantitative (picture-linked, ordinal score) assessment of caries, peridontal status and plaque (in 12 segments of teeth) before randomisation (to the use of either toothbrush, jumbo swab or sonic toothbrush) by pre-assigned sealed envelopes. All teeth were cleaned (prescribed four hourly) with 0.2% chlorhexidine solution. Daily plaque scores were obtained (by an assessor (SC) blind to treatment allocation) until withdrawal, death or transfer.Results Toothbrush Jumboswab SonicPatients assigned 50 48 39Withdrawn within 24hrs. 9 3 5Patients remaining 41 45 34Percentage of teeth segments thatare pristine: pre treatment 45 50 51 after 2 days 74 57 90 F(2.63) = 5.00 p = 0.0097 More withdrawals for patient noncompliance after randomisation occurred in the sonic group (5/34 versus 3/86). Conclusion. By the second day the sonic toothbrush was the most effective in plaque removal with the toothbrush the next most effective method
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Pearce, L., Kirkham, S., & Cuthbertson, S. (1996). Quality of follow-up for self-poisoning patients after discharge from intensive care: 1996, one year later. Ph.D. thesis, , .
Abstract: In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care.
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Margetts, M., Cuthbertson, S., & Streat, S. J. (1995). Bereavement follow-up service after fatal critical illness. Ph.D. thesis, , .
Abstract: Fatal illness is often short. Communication between patient and family is impaired and how to best meet family needs is unclear. We began a follow-up service to determine current next-of-kins outcomes and remedy service deficiencies. A critical care nurse identified deaths from our data base and completed a structured telephone interview with the next-of-kin. There were 374 admissions from 1/1/95 – 17/5/95, 55 died. Next- of-kin of 52 patients (M29, age 19-88 median 52) were contactable 16-70 (median 33)days later. All (defacto/wives 18, husbands 9, mothers 9, daughters 8, others 8) consented to interview (5 -80, median 15 minutes). Forty-nine had resumed normal home activities and 23/25 workers had returned to work. Thirty-three still had disturbed sleep, three were taking hypnotics. Twenty-four had had contact with their general practitioner because of the death (six were prescribed sedatives or hypnotics). Nineteen had financial problems. Forty-seven described DCCM care positively, 35 specifically (nursing care and compassion 15, communication 8, flexible visitors policy8) but 13 had particular difficulties (communication 4 , waiting 2, facilities 4) and 4 serious non-DCCM issues. Forty-six considered themselves well informed and understood well the sequence of events. Forty-eight identified family and friends as primary support. Three requested information about another agency (counseling), 9 asked us to contact as further relative. A telephone bereavement service is well received by next-of-kin. Most families members resolve their early grief without external agencies but sleep and money are problems. We have improved our facilities and are addressing communication and cultural issues
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Key, R., Cuthbertson, S., & Streat, S. J. (1995). Critical care survivors follow-up service. Ph.D. thesis, , .
Abstract: The extent of early remediable morbidity after critical illness is unclear. We began a follow-up service to determine outcomes, facilitate rehabilitation and remedy service deficiencies. A critical care nurse identified hospital survivors (DCCM and hospital databases), completed a structured telephone interview with the patient and intervened according to predetermined guidelines. Of 261 admission 1/1/95 29/3/95 50 died in hospital (39in DCCM). Of 211 hospital survivors (M115, age 15-84 median40) 31 could not be contacted, one died at home and 179 contacts were made 21- 120 (median 51) days after DCCM. One refused interview, 178 interviews took 8-60, (median 15) minutes. Only 68/178 had resumed normal activities and 26/78 workers had returned to work. Seventy patients had contacted general practitioners because of critical illness sequelae. One hundred patients gad 191 problems (including unhealed wounds29, pain 28, impaired mobility26, neurological deficit 178, infection 10 weight loss 9, tiredness 6 depression 5, sleep disturbance 3, others 57). Sixty-five described DCCM staff as helpful, 37 had complaints (hallucinations 6, staff behaviour5, restraints5 sedation/analgesia inadequate5 or excessive 2, poor communication3, fear3, noise 2 other 4) and 5 raised serious non-DCCM issues. Forty-four patients were called again 6-84, median 42 days later when 69/112 health problems had resolved but 29/44 patients had not resumed normal activity. Four attended a clinic and were referred to other services. A follow-up service is well received. Morbidity is common but improves within three months after critical care. We are addressing service issues
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Blue, R. G. (1995). A new net goes out fishing: options for change within the public health nursing service. Ph.D. thesis, , .
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