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Litchfield, M. (2004). Achieving health in a rural community: A case study of nurse – community partnership. Wellington: Litchfield Healthcare Associates.
Abstract: This study describes rural, nurse-led health services provided by the Takapau Health Centre (Central Hawkes Bay) and its outreach, Norsewood & District Health Centre. The study looks at its model of service delivery through to 2002. It examines the establishment, development, funding and management of the service, along with the nursing practice and the healthcare people received. The book is a snapshot of nursing initiative and survival through a decade of change in health policy and service funding and delivery. The information was subsequently used to move the health centre service into the new paradigm of primary health care launched in the New Zealand Health Strategy.
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Jacobs, S. (2003). Advanced nursing practice: Time and meaning. Nursing Praxis in New Zealand, 19(3), 29–39.
Abstract: The particular, contemporary meanings ascribed to “advanced nursing practice” in New Zealand have been debated and delineated in the 1990s, culminating in the launch of the nurse practitioner role at a conference sponsored by the Ministry of Health and the Nursing Council of New Zealand in August, 2001. Drawing on archival materials, documents, other texts and voices, this article explores the evolution of connotations and meanings of the word “advanced” as applied to nursing in New Zealand. The focus is on clinical practice, research, teaching, consulting, higher education, and advancement of the profession. Historical aspects of advancement in New Zealand nursing are examined, including registration, unsupervised practice, technical specialisation, and career development.
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Connor, M. (2003). Advancing nursing practice in New Zealand: A place for caring as a moral imperative. Nursing Praxis in New Zealand, 19(3), 13–21.
Abstract: The author argues that the framework of competencies required for advanced nursing practice should include a moral dimension in order to take account of relational as well as functional competencies. There is no recognition of the relational competencies required to practice caring as a moral imperative. The Nursing Council of New Zealand expects that nurses will practise 'in accord with values and moral principles'. The paper explores the history of two nursing discourses, that which sees nursing as a functional occupation and that which emphasises the relationship between nurse and patient. A practice exemplar is used to demonstrate positive outcomes from advanced relational competencies.
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Carryer, J. B., & Boyd, M. (2003). The myth of medical liability for nursing practice. Nursing Praxis in New Zealand, 19(4-12), 4–12.
Abstract: This article explores the complex nature of liability in the case of standing orders and vicarious liability by employers, and also when nurses and doctors are in management roles. The authors address misconceptions about medico-legal responsibility for nursing practice with the advent of nurse prescribers and nurse practitioners. They refer to the submission made by the College of Nurses Aotearoa (NZ) on the Health Practitioners Competence Assurance Act (2003), and discuss practice liability and nurse-physician collaboration.
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Fraser, A. G., Williamson, S., Lane, M., & Hollis, B. (2003). Nurse-led dyspepsia clinic using the urea breath test for Helicobacter pylori. Access is free to articles older than 6 months, and abstracts., 116(1176).
Abstract: Reports the audit of a nurse-led dyspepsia clinic at Auckland Hospital. Referrals to the Gastroenterology Department for gastroscopy were assessed in a dyspepsia clinic. Initial evaluation included consultation and a urea breath test (UBT). Patients given eradication treatment prior to initial clinic assessment were excluded. Patients with a positive UBT were given eradication treatment and were reviewed two months later for symptom assessment and follow-up UBT. Patients with a negative UBT were usually referred back to the GP. There were 173 patients with a mean age 38 years. The urea breath test was found to be useful as part of the initial assessment of selected patients who would otherwise have been referred for endoscopy. It is likely that the need for gastroscopy was reduced, but longer follow up will be required to determine whether or not this effect is simply due to delayed referral. This approach is likely to have value only in patients who have a relatively high chance of being H. pylori positive.
Keywords: Advanced nursing practice; Hospitals; Clinical assessment; Evaluation
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Smythe, E. (2003). Uncovering the meaning of 'being safe' in practice. Contemporary Nurse, 14(2), 196–204.
Abstract: This paper moves away from the prevalent discourse of competence to consider the meaning of the experience of 'being safe' within the context of childbirth. It offers findings from a doctoral study, informed by the philosophies of Heidegger and Gadamer. Following ethical approval, the data was collected in New Zealand by tape-recorded interviews of 5 midwives, 4 obstetricians, 1 general practitioner and 10 women. The method was informed by van Manen. The findings reveal that in seeking the meaning of being safe one needs to be aware that the unsafety may already be present in the situation. Practitioners may be able to do little to rectify the unsafeness. There is, however, a spirit of safe practice, explicated in this paper, that is likely to make practice as safe as it can possibly be. Wise practitioners are ever mindful that a situation may be or become unsafe, and are always aware of their own limitations.
Keywords: Childbirth; Patient safety; Advanced nursing practice; Midwifery
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Speed, G. (2003). Advanced nurse practice. Nursing dialogue: A Professional Journal for nurses, 10, 6–12.
Abstract: The concept and characteristics of advanced nursing practice in New Zealand and overseas is compared with the nurse practitioner role. There is an international debate over definitions of advanced nursing and the range of roles that have developed. The rationale for the nurse practitioner role in New Zealand is examined, along with the associated legislation currently before Parliament. Job titles and roles of nurses within the Waikato Hospital intensive care unit are discussed and ways of developing the role of nurse practitioner are presented.
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Hales, A., & Dignam, D. (2002). Nurse prescribing lessons from the US. Kai Tiaki: Nursing New Zealand, 8(10), 12–15.
Abstract: The researchers present a survey of a sample population of 32 advanced practice nurses (APN) in the US about their experiences of acquiring and implementing prescriptive authority. The issues relevant to nurse practitioners in New Zealand are discussed, around acquiring knowledge and education, relationships with other professionals, establishing the role, and retaining the nursing role. The intent and scope of APN prescribing in the US is also discussed.
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Brookes, K. (2001). Moving stories from nurses in flight. Ph.D. thesis, , .
Abstract: This thesis contains a collection of stories gifted by four New Zealand Retrieval Team nurses who are experienced in the transport of patients. These nurses are commonly called flight nurses and they assist in the transport of patients via helicopter, fixed-wing aeroplane, large commercial aeroplanes and ambulances. While their practice is not exclusively in the helicopter there is an emphasis on this mode of transport in this thesis. Flight nursing is a scope of nursing practice where the use, and visibility, of nurses' stories is rare. The specific context of this research is positioned in one tertiary intensive care unit in New Zealand but it is anticipated that the stories from four flight nurses and the author's subsequent thoughts on them will resonate with flight nurses in other regions. The stories were collected using a storytelling methodology that has been informed by qualitative and feminist perspectives. The stories were either gathered and shaped using interview and transcription techniques with the storyteller and the researcher, or written by the storyteller. The thesis has been written as a narrative and chronicles the journey to the point of receiving the stories and the lines of inquiry in which they subsequently directed the author. The stories are central to this research and appear in their entirety. The reader is encouraged to create their own meaning from the stories. The stories themselves have several common threads, which are planning, communication, teamwork and the unexpected. The threads underpinning the stories are not unique to flight nursing practice and have been discussed in other scopes of practice. One area the author has chosen to explore in more depth is the impacts of technology, privacy, narrative pedagogy and disenfranchisement on the visibility of flight nurses' stories. The other area she has chosen for discussion is advanced and specialty nursing practice as it relates to flight nurses. As a result of this discussion she proposes her own view for advanced and specialty practice in flight nursing.
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Clendon, J., & White, G. E. (2001). The feasibility of a nurse practitioner-led primary health care clinic in a school setting: A community needs analysis. Journal of Advanced Nursing, 34(2), 171–178.
Abstract: The aim of this study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a New Zealand primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses were the most appropriate nurses to lead such a clinic. Utilising a community needs analysis method, data were collected from demographic data, 17 key informant interviews and two focus group interviews. Analysis was exploratory and descriptive. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the public health nurse was less than anticipated and that community expectations were such that for a public health nurse to lead a primary health care clinic it would be likely that 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 plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. The authors conclude that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was 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.
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Ross, J. (2001). Perspectives on developing the advanced role of rural nursing in New Zealand. Health Manager, 8(1), 19–21.
Abstract: The author traces the development of rural nursing, which began as an assistant role for general practitioners, to the present role which incorporates advanced nursing practice. She reports the results of two surveys of nurses' roles and skills, from 1996 and 1999-2000. Specific rural competencies are identified, in managing isolation, professionalism in a small community, nurse/patient relationships in a small community, and independence.
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Jacobs, S. (2000). Credentialling: Setting standards for advanced nursing practice. Nursing Praxis in New Zealand, 15(2), 38–46.
Abstract: This article examines professional regulation with particular reference to advanced practice. As well as providing an overview of credentialing and other aspects of professional regulation, including licensure, certification, registration, and titling, the question of how much regulation, and by whom, is explored.
Keywords: Scope of practice; Advanced nursing practice
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Logan, C. M. (2000). Anaesthetic nursing: Focusing perioperative practice on the patient.
Abstract: The purpose of this literature review is to generate a picture of what is known and what needs to be investigated further about anaesthetic nursing in the perioperative nursing role in New Zealand, and to examine this in relation to international trends. Nurse anaesthetists in the United States are described in American nursing literature, and recognised as one of the four advanced nurse practitioner roles. In New Zealand, recent efforts to provide appropriate post-graduate education for the perioperative nurse have been challenged by other inter-professional interests, thus restricting the development of an expanded role. The author notes that this has caused concern for New Zealand's perioperative nurses who consider anaesthetic nursing is an integral part of perioperative practice. Anaesthetic nursing forms a substantial component of the basic competencies required of a registered nurse working in the operating theatres. Orientation programmes and ongoing education at all levels of professional development incorporate anaesthetic nursing competencies to provide continuity of patient care and support perioperative practice. Care of the patient undergoing anaesthesia is an area where nurses demonstrate their advanced assessment skills and clinical judgement and is included in perioperative specialist or nurse practitioner job descriptions. The Perioperative Nurses Association in New Zealand is concerned to develop postgraduate education in their area of speciality to support their application for 'College' status within the New Zealand Nurses Organisation. For this to happen in a cogent fashion, information and knowledge generated from research, are required to clarify perioperative nursing's current position and determine how practice can be shaped to best care for patients undergoing surgical interventions. Evidence from research supports nurses in the anaesthetic role by demonstrating that the preoperative visits and assessments they undertake can reduce patients' anxieties, decrease the need for pain relief and shorten hospital stays. This review includes literature sources that explore disparities between the development of New Zealand anaesthetic nursing and international models. The author suggests that information and understanding gained from conducting this review will allow future developments in anaesthetic nursing practice to be informed by previous initiatives and projects and identifies areas for further research.
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Chadwick, A., & Hope, A. (2000). In pursuit of the named nurse. Australasian Journal of Neuroscience, 13(4), 6–9.
Abstract: This paper outlines the project outcomes, benefits, impact and constraints of introducing the named nurse concept to a neuro-services department. The concept of the named nurse was first introduced in the UK, in 1992, with the aim of supporting the partnership in care between the patient and the nurse. The evidence for the effectiveness of introducing the named nurse concept is largely anecdotal. In line with the hospital wide policy of implementing the named nurse concept at Auckland Hospital, a six-month pilot study was undertaken within the Neuro-services Department. The aims of the study were to foster a partnership in care with patients / whanau and the multidisciplinary team, to improve the efficiency and effectiveness of delivery of nursing care, and to contribute to continuous quality improvement. The results highlighted that, in theory, the named nurse concept would be effective in providing quality co-ordinated care, however factors were identified that hindered the effectiveness of its implementation. Therefore, further development of the concept was required.
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Christensen, D. J. C. (1999). Integrating the terminology and titles of nursing practice roles: Quality, particularity and levelling. Nursing Praxis in New Zealand, 14(1), 4–11.
Abstract: The author reconsiders the meaning of expert, specialist and advanced practice. She proposes that they are distinctive and complementary aspects of every nursing role and suggests a set of attributes for each. Expertise is discussed in terms of the quality of performance, speciality in relation to particularity of performance, and advanced practice with regard to the level of performance.
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