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Author  |
Macfarlane, K. |
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Title |
Communicating changes in a patient's condition: A critical incident approach |
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Year |
2006 |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Keywords |
Communication; Clinical assessment; Physicians; Nursing; Relationships |
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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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Call Number |
NRSNZNO @ research @ |
Serial |
724 |
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Author |
Magrath, K.L. |
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Title |
From chrysalis to butterfly: Transition experiences of new graduates in primary health care nursing practice in New Zealand |
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Year |
2005 |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Keywords |
Primary health care; New graduate nurses; Mentoring |
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Abstract |
Primary health care is a dynamic and ever-changing area of practice which has undergone many changes in the last ten years. Traditionally, primary health care was not a routine choice for new graduate nurses as they were encouraged to work in a hospital setting before seeking a position in the community. Bachelor of Nursing programmes emphasise primary health care practice and increasingly nurses and their employers are moving away from the traditional belief of 'doing your time in the hospital' before contemplating the move to primary health care. Currently in New Zealand increasing numbers of graduates from Bachelor of Nursing programmes want to begin their working life as registered nurses in this area. A constructivist approach was taken to explore the experience of five nurses who entered primary health care practice as new graduates. Participants were interviewed using a semi-structured format. They constructed their experience as role transition and identified a number of significant factors which had impacted on their practice. These factors included both the personal and practice challenges they experienced and the strategies they used to address them. Further research findings were a transition time of one year, the importance of both formal and informal support, planned orientation and opportunities for reflection. A number of mediating factors including new graduate programmes, peer support and mentorship were also discussed. Key implications for practice, education, employers and future research regarding transition to primary health care for new graduates are discussed. This research emphasised the importance of appropriate resources and support for new graduates from Bachelor of Nursing programmes. These factors are suggested as integral to the development of new graduates' practice in primary health care and reduction of the challenges inherent in this transition. |
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Call Number |
NRSNZNO @ research @ |
Serial |
587 |
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Author |
Manning, J. |
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Title |
Skin-to-skin care of the very low birth weight infant: Taking a risk and making it happen |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Keywords |
Paediatric nursing; Premature infants; Nursing; Hospitals |
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Abstract |
Parent-infant skin-to-skin care has become an advocated aspect of care in neonatal intensive care units nationally within New Zealand and internationally. However the implementation of this care by nurses can be limited by a number of factors within the practice environment. This dissertation presents a critical analysis of literature alongside reflection on the author's own practice experience to explore factors that may be constraining the use of skin-to-skin care with the very low birth weight infant in the neonatal intensive care unit. These factors are examined through a lens of risk taking behaviour underpinned by the grounded theory work of Dobos (1992). The concept of risk is explored in order to develop an understanding of why, in the author's view, the practice of skin-to-skin care of very low birth weight infants may have declined in recent years. For neonatal nurses skin-to-skin care of the very low birth weight infant presents challenges related to the environment, physiological stability of the infant and changes over the past 10 years in the clinical management of very low birth weight infants. As progress is made toward the design, development and eventual move to a new unit in Dunedin recommendations pertaining to the change in physical space, the introduction of a structured model for nursing care and implications for nursing practice development in relation to skin-to-skin care are described. |
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NRSNZNO @ research @ |
Serial |
800 |
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Author |
Marshall, K. |
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Title |
Enteral nutrition within 72 hours after spinal chord injury: Complexities and complications |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Issue |
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Pages |
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Keywords |
Nursing; Intensive care nursing |
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Abstract |
Good nutrition is essential following acute spinal cord injury. Poor nutrition can lead to the deleterious effects of protein-calorie induced hypermetabolism and poor functional and rehabilitation outcomes. Nutritional management for patients with acute cervical or high thoracic spinal cord injury admitted to the Canterbury District Health Board's Burwood Spinal Unit and Christchurch Hospital's Department of Intensive Care Medicine (CHDICM) differ. The Burwood Spinal Unit has a delayed approach to nutritional management in contrast to the implementation of early enteral feeding by CHDICM. This prompted a literature review to critically consider the evidence underpinning clinical practice in this field. Literature revealed that nutritional management in the first 72 hours after spinal cord injury is a complex process. The complexities of when to commence, the method of delivering, and the target dose of enteral nutrition in the first 72 hours after spinal cord injury are due to the perceived risk of a spinal ileus and the ensuing, such as adverse effects on abdominal and respiratory function, resulting from enteral feeding intolerance. Literature revealed that delayed nutrition is largely based on expert opinion, while early enteral feeding has limited but stronger scientific research evidence. Nevertheless, it is desirable to use the best evidence currently available to develop, implement and evaluate an evidence-based, protocol driven, clinical pathway for nutritional management of patients within 72 hours of an acute cervical or high thoracic SCI. The author concludes that to ensure an acute spinal cord injury clinical pathway is based on scientific evidence, prospective, multi-centre, randomised controlled trials are needed to substantiate early enteral feeding and identification of the degree of and risk of complications from spinal ileus after acute cervical or high thoracic spinal cord injury. |
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Call Number |
NRSNZNO @ research @ |
Serial |
809 |
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Author |
Maw, H. |
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Title |
The challenge of developing primary health care nurse practitioner roles in rural New Zealand |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Keywords |
Nurse practitioners; Rural health services; Primary health care |
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Abstract |
When the New Zealand Nursing Council introduced the nurse practitioner as a new level of nurse in 2001, the opportunity arose for the introduction of primary health care nurse practitioners into the rural practice arena in this country. This dissertation explores the influences on the development of rural nursing in the last decade in New Zealand including the role of the Centre for Rural Health in advancing rural nursing education, as well as the impact the shortage of health professionals in rural New Zealand has had on the development of the rural primary health care nurse practitioner concept. For pioneering primary health care nurse practitioner roles to be successfully implemented in rural communities in New Zealand, several challenges need to be faced; the creation of roles and employment opportunities, community acceptance of the role, medical and nursing acceptance of the role and the establishment of independent nurse prescribing within the constraints imposed by current legislation. The dissertation explores the current literature in an attempt to offer solutions to the identified challenges. With the creation of primary health care nurse practitioner roles and the establishment and acceptance of these roles in rural communities, a new mode of health service delivery in rural New Zealand will begin. |
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Call Number |
NRSNZNO @ research @ |
Serial |
576 |
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Author |
McGirr, S. |
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Title |
New graduate nurses clinical decision making: A methodological challenge |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Issue |
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Pages |
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Keywords |
New graduate nurses; Clinical decision making; Methodology |
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Abstract |
New graduate nurses, particularly in the first year of clinical practice, face challenges with making clinical decisions about patient care. A review of the literature revealed no studies that reported using fundamental qualitative descriptive methodology to investigate new graduate nurses' clinical decision making. Aspects of decision making by new graduates have been studied using observational and interview methods, the findings from which have been interpreted using various theoretical decision making models. There has been little research outside of the context of critical care or intensive care units, but anecdotal reports in 2006 from the New Zealand Nursing Entry to Practice Programme (NetP) coordinators network suggest that new graduates are seldom employed in critical care or intensive care units in New Zealand. Nursing educators involved in undergraduate nurse training and NetP programmes need to understand how new graduates perceive, experience and manage decision making in clinical practice, in order to assist them to develop and refine those skills. There is a need for studies utilising fundamental qualitative descriptive methodology in order to explore the experiences of new graduates' decision making in clinical practice. The author notes that the topic is particularly relevant in light of the introduction of the national NetP programmes framework in New Zealand, and to her role as a NetP programme coordinator. This dissertation examines the relevant literature about decision making by new graduates and the research methods that were used, and concludes that fundamental qualitative descriptive method is a highly appropriate method by which to study new graduates' decision making. |
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Call Number |
NRSNZNO @ research @ |
Serial |
818 |
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Author |
McNab, M. |
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Title |
The nursing roles in respect of tuberculosis in New Zealand from 1928 to 1966 |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Pages |
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Keywords |
History; Nursing; Tuberculosis |
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Abstract |
In this thesis the nursing roles in respect of tuberculosis in New Zealand from 1928 to 1966 are identified, and then examined by contextualising them in relation to the changing social, political, demographic, scientific and technological environments in which the treatment and prevention of tuberculosis took place. The history of the various institutions is described in order to show some of the circumstances that led to the evolution of the roles of dispensary nurse, district nurse, school nurse, public health nurse, sanatorium nurse, and hospital nurse. 1928 to 1966 covers a sufficiently long period of intensive activity and change in the detection, treatment and research of pulmonary tuberculosis in New Zealand, to enable comparisons between nursing roles to be made. It was found that nurses had an individualised approach to their work. This was defined by the physical environments within which they worked, whether it was a hospital, sanatorium, dispensary, school or in a patient's home. Also, the medical treatments advocated and implemented by the medical practitioners, the rules and regulations which governed the various work areas, and the availability of staff, funds, facilities and resources all had an impact upon how nurses were able to work and how their respective roles developed. In addition, some of the factors which contributed to nurses getting tuberculosis and the initiatives to improve the nurse's conditions of work are examined, because these had an impact on the performance of the nurse's work and evolution of her role. Apart from practical nursing care, nurses also had a role in the on-going inspection, monitoring, notification, emotional support of patients and families, morale boosting and education. Each role had these components. The differences were in the time and emphasis given to each. |
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Call Number |
NRSNZNO @ research @ |
Serial |
660 |
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Author |
Medlin, E. |
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Title |
Practice nursing: An autoethnography: Changes, developments and influences |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Pages |
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Keywords |
Practice nurses; Community health nursing |
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Abstract |
Practice nurses work in general practice providing an increasingly autonomous service to consumers of primary health care. Autoethnography is a biographical method of research that describes personal experience in terms of society and culture and is the theoretical foundation of personal narratives and storytelling. Throughout history, stories have been used as a means of communicating and learning which with reflection, allows new meanings to develop for all participants. This autoethnography is the author's story of practice nursing and it discusses her experience of being a practice nurse over the past 12 years. It is autobiographical and reflexive and charts the changes that she has found in her practice during this time. Some of these changes have arisen from influences personal to her practice, others because of influences on practice nursing in general, but all are intertwined. Education and professional development, leadership and government policies are identified as the major influences on her practice. A discussion of these influences enables recognition of the changes, advancement and expansion of services thereby allowing others to share the experience and find meaning within it. |
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Call Number |
NRSNZNO @ research @ |
Serial |
745 |
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Author |
Mitchell, P. |
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Title |
Grade-1 pressure ulcer: Review of prevention evidence for “at risk” patients in an acute environment |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing |
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Abstract |
This dissertation is a review of evidence underpinning the recommendations for pressure ulcer prevention from four national guidelines frequently used as a foundation for best practice. The focus is on grade-1 pressure ulcer prevention for “at risk” patients, in the acute environment. Rationale: Prevention is better than cure. While preventive strategies maybe effective are they supported by evidence? Results: The strongest evidence for best practice appears to be limited to an established fact that standard hospital mattresses should at least be replaced by high specification foam, pressure reducing mattresses for patients “at risk” or vulnerable to pressure ulcer development. Repositioning, skin assessment, skin protection and maintenance, traditionally the basis of pressure ulcer prevention, appear to have a paucity of strong supportive evidence. Further evidence is emerging on clinically important areas such as erythema and mattresses. Implications for Nursing: The organisational or ministerial support for education of the multidisciplinary team, especially nurses in risk assessment and prevention strategies. This support is required both in release time and finances for education and in adequate funding for preventive strategies. The author concludes that strong evidence to support the recommendations of the guidelines appears to remain limited, particularly in the acute environment. Expert opinion would appear to remain the basis for current best practice for pressure ulcer prevention. The volume and consistency of this evidence worldwide is substantial and adds validity to the recommendations. Best practice includes firstly risk assessment, skin assessment, maintenance of skin temperature, moisture, and condition, and the importance of repositioning, in conjunction with an appropriate support surface. However gaps remain in the supportive evidence in many of these fields. Advances in practice include pressure relief or reduction considerations for all surfaces the patients encounter. There appears to be no gold standard for prevention of pressure ulcer development. |
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Call Number |
NRSNZNO @ research @ |
Serial |
814 |
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Author |
Paterson, J.E. |
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Title |
Nurses' clinical decision-making: The journey to advancing practice |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Clinical decision making; Mentoring; Nursing; Nurse practitioners |
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Abstract |
This dissertation reports on a scholarly journey to better understand the processes of clinical decision-making by nurses. It begins by identifying the various terms used to describe a clinical decision, its components and the contexts within which clinical decisions are made. Two philosophies of decision-making are summarised. Some insight into the history of the phenomenological and the rationalist theories of decision-making is offered. The author notes that it became evident that both of these theories are applicable to all nurses and their clinical decision making competencies. Four studies that were undertaken to analyse the decision-making methods of nurse practitioners are critiqued. Of the studies two are British, one is American and one is Australian. The author has summarised the combined findings that identified that the nurses were using a blend of decision-making processes that involved rational decision making as well as the use of intuition. The studies identified that sound clinical decision-making is determined by appropriate educational and clinical preparation and supported by a formal mentoring process and the use of critical reflective practice. In conclusion, the author reflects on her knowledge of decision making prior to embarking on the dissertation and states her intent to facilitate and support advanced decision-making by her colleagues. She goes on to say that uppermost is the need for an institutional and managerial environment that encourages advanced and independent decision-making by nurses. |
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Call Number |
NRSNZNO @ research @ |
Serial |
681 |
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Author |
Patrick, S. |
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Title |
A nursing role in rural adolescent sexual health |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Sexual health; Adolescents; Nursing; Rural health services |
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Abstract |
This dissertation explores the nurse's role in addressing the sexual health needs of a rural adolescent community in New Zealand. The increasing incidence of adolescent sexual activity is widely recognised and it is acknowledged that youth face unique barriers to health care. These barriers are particularly apparent in access to contraception with a resulting increase in the rates of sexually transmitted infections, unintended pregnancies and termination of pregnancies. These deteriorating adolescent sexual health statistics are of particular concern within New Zealand's health sector. A review of national and international literature examined the potential nursing role in adolescent sexual health. Results provide strong evidence that experienced nurses can competently and confidently assist in meeting the needs of this population group, especially in rural areas. Literature consistently concluded that nurses could provide care that is as effective as that provided by a doctor. School-based health clinics are identified as a viable way to improve access to adolescent sexual health services. In conclusion, the author suggests that nurses are in a key position to provide an alternative model of health care delivery that can improve adolescent sexual health. |
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Call Number |
NRSNZNO @ research @ |
Serial |
821 |
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Author |
Pepers, M.G. |
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Title |
A grey zone: The experience of violence in remote nursing practice |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Workplace violence; Rural health services; Rural nursing |
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Abstract |
This dissertation explores the issues affecting the exposure of isolated rural nurses working in New Zealand to violence from members of the local community, including the visiting public. Discussion on the collaborative role with the New Zealand Police is thematic in the issues presented. Challenges presented include the unique community dynamics of the Stewart Island nursing practice on the Island, with scope of practice, isolation and practice issues included. Role definition, present-day health-care delivery, the potential for violence including causation and reporting are presented. Incident management and risk strategies, including de-escalation are rationalised and described. Evidence for the nurse-police inter-service relationship along with issues including confidentiality and legislation are reviewed. Recommendations and conclusion are provided. The thread and theme of the dissertation is to encourage discussion within nursing circles on the provision of satisfactory safety standards for nurses working in remote isolated parts of New Zealand. |
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Call Number |
NRSNZNO @ research @ |
Serial |
688 |
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Author |
Roberts, C. |
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Title |
The influence of nursing culture on family visiting in adult intensive care units |
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Year |
2007 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Intensive care nursing; Nurse-family relations; Culture; Nursing |
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Abstract |
This dissertation considers the implications of the relationship between nurses and the patient's family, when family members visit intensive care units (ICUs) following the acute admission of a relative there. In particular it explores the issues of power and control, nurses might have in this setting, the culture that supports that, and the implications this has for practice in the New Zealand context. A comprehensive literature review on the perspective of nurses in relation to relatives visiting adult intensive care units was conducted. The author concludes that nurses modify policies related to visiting access for family members to suit themselves, and the needs of their patient. Nurses use a variety of tactics to maintain a position of power and control by looking out for themselves first, their patient second, and relatives third. The need of the patient and their families is not well understood by nurses, and nurses feel they have inadequate skills to cope with the needs and stresses of visiting relatives. The author suggests that for nurses to provide family focused care in ICU they must develop a therapeutic relationship with all concerned. ICU nursing culture affects nurses ability to focus on caring for their patients and their families. Nurses in ICU appear to need to maintain power and control over their environment but further research is needed to identify the current situation in New Zealand ICUs. |
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Call Number |
NRSNZNO @ research @ |
Serial |
502 |
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Author |
Roberts, M.H. |
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Title |
An exploration of the experiences of Maori nurses in Aotearoa/New Zealand |
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Year |
2004 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Maori; Nursing; Cultural safety; History |
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Abstract |
The author describes the purpose of her writing as exploring the journeys that Maori have experienced within the nursing profession of Aotearoa/New Zealand. It presents the reader with insight into these journeys by examining a broad range of events and experiences from pre European contact up to contemporary times. The intention of providing these insights is for the reader to be made aware of not only the “uniqueness” that Maori nurses bring to the profession in New Zealand but to give voice to the many untold experiences of Maori nurses. The Nursing Council of New Zealand (NCNZ), numerous Maori and non- Maori academics have long acknowledged the uniqueness of Maori health perspectives and needs. However, the author notes there is limited literature which specifically discusses experiences of Maori consumers of health services and until recently, exploration of the experiences of Maori nurses has been limited. The Ministerial Taskforce of Nursing (1998) identified the paucity of research related to Maori nursing and acknowledges the need for Maori nurses to develop a body of knowledge specifically focused in this area. To this end, the author intended that this work would contribute to the increasing body of knowledge regarding this unique group within the nursing profession of Aotearoa/New Zealand.The discussion includes revisiting the history of nursing in Aotearoa/New Zealand and critiquing the participation of Maori nurses. The experiences of Maori nurses and students from within the education sector is detailed with a particular focus on their experiences of Kawa Whakaruruhau / Cultural safety. Contemporary issues for Maori nurses are critiqued and possible solutions offered along with details of the writer's vision for the future direction of Maori within the wider nursing profession in Aotearoa/New Zealand. |
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Call Number |
NRSNZNO @ research @ |
Serial |
593 |
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Author |
Robertson, A.M. |
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Title |
Meeting the maternity needs of rural women: Negotiating the reality of remote rural nursing and midwifery practice |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
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Volume |
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Issue |
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Pages |
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Keywords |
Rural nursing; Midwifery |
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Abstract |
Recent changes to the way that health services are provided and issues related to the rural health workforce are creating an international crisis in the availability of rural maternity care. International trends show a workforce decline in rural general practitioner obstetric specialists and rural midwives, as well as a decline in rural births. The aim of this study is to highlight the maternity needs of rural New Zealand women. Further, it discusses how the changes to maternity services in New Zealand, over the last sixteen years, have impacted on the rural nurse and midwife role and therefore on service provision. This information is intended to identify issues that could be used as the basis for development of a uniquely rural model of maternity care. |
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Call Number |
NRSNZNO @ research @ |
Serial |
510 |
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