| Records |
| Author |
Ardagh, M.; Wells, E.; Cooper, K.; Lyons, R.; Patterson, R.; O'Donovan, P. |
| Title |
Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: A controlled prospective trial |
Type |
Journal Article |
| Year |
2002 |
Publication |
New Zealand Medical Journal |
Abbreviated Journal |
Access is free to articles older than 6 months, and abstracts. |
| Volume |
115 |
Issue |
1157 |
Pages |
|
| Keywords |
Emergency nursing; Time factors; Clinical assessment; Clinical decision making |
| Abstract |
The aim of this study was to test the hypothesis that triaging certain emergency department patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. During the five weeks of the RAC clinic a total of 2263 patients attended the emergency department, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the emergency department. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The researchers found that the rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources. |
| Call Number |
NRSNZNO @ research @ |
Serial |
617 |
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| Author |
Bickley, J. |
| Title |
A study of medical, nursing, and institutional not-for-resuscitation (NFR) discourses |
Type |
|
| Year |
2002 |
Publication |
|
Abbreviated Journal |
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| Volume |
|
Issue |
|
Pages |
317 pp |
| Keywords |
Clinical decision making; Attitude of health personnel; Hospitals; Terminal care |
| Abstract |
This study investigates the way that medical, nursing and institutional discourses construct knowledge in the specific context of Not-for-resuscitation (NFR)in a New Zealand general hospital where NFR guidelines are available in the wards and from the regional ethics committee. The thesis argues that there are ranges of techniques that staff use to construct NFR knowledge, enacted through various forms of speech and silence, which result in orderly and disorderly experiences for patients nearing death. The study was conducted through a critical analysis of the talk of health professionals and the Chairperson of the Regional Ethics Committee. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1117 |
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| Author |
Blair, K.M. |
| Title |
Recognising the sick patient: An emergency nurses view: A research paper |
Type |
|
| Year |
2006 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
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| Keywords |
Emergency nursing; Patient safety; Diagnosis; Training; Clinical decision making |
| Abstract |
This paper reports on a literature review that examines how health professionals (mainly nurses) recognise the signs of physical deterioration in their patients. It includes discussion of how nurses' clinical decision making skills influence how physical deterioration is identified and determines what changes in the delivery of care could have an impact on emergency department patients at risk of life threatening deterioration. |
| Call Number |
NRSNZNO @ research @ |
Serial |
467 |
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| Author |
Bunn, S. |
| Title |
An exploration of the transition of patients from intensive care to the ward environment: A ward nursing perspective |
Type |
|
| Year |
2007 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Clinical decision making; Nursing; Communication |
| Abstract |
The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments. |
| Call Number |
NRSNZNO @ research @ 827 |
Serial |
811 |
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| Author |
Gaskin, C.J.; O'Brien, A.P.; Hardy, D.J. |
| Title |
The development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand |
Type |
Journal Article |
| Year |
2003 |
Publication |
International Journal of Mental Health Nursing |
Abbreviated Journal |
|
| Volume |
12 |
Issue |
4 |
Pages |
259-270 |
| Keywords |
Professional competence; Psychiatric Nursing; Clinical decision making; Nursing research |
| Abstract |
This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand district health board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1064 |
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| Author |
Ho, T. |
| Title |
Ethical dilemmas in neonatal care |
Type |
Journal Article |
| Year |
2000 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
|
| Volume |
6 |
Issue |
7 |
Pages |
17-19 |
| Keywords |
Intensive care nursing; Paediatric nursing; Ethics; Clinical decision making |
| Abstract |
The author explores possible approaches to the ethical dilemma confronting nurses of critically ill premature infants with an uncertain or futile outcome despite aggressive neonatal intensive care. A case history illustrates the issues. The morality of nursing decisions based on deontological and utilitarian principles is examined, as are the concepts of beneficence and non-maleficence. A fusion of virtue ethics and the ethic of care is suggested as appropriate for ethical decision-making in the neonatal intensive care environment. |
| Call Number |
NRSNZNO @ research @ 1035 |
Serial |
1019 |
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| Author |
Lake, S.E. |
| Title |
Nursing prioritisation of the patient need for care: Tacit knowledge of clinical decision making in nursing |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
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| Keywords |
Clinical decision making; Nursing |
| Abstract |
Effective nursing prioritisation of the patient need for care is integral to daily nursing practice but there is no formal acknowledgement or study of this concept. Utilising the retroductive research strategy of critical realism, this thesis explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. The tacit knowledge discerned within the literature indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Such nursing prioritisation takes place concurrently between the competing or even conflicting needs of the several individual patient presentations within the nurse's caseload. Varied frames of reference within different practice settings create specific imperatives on this dynamic and non-sequential process. Starting with an initial set of studies in the 1960s, study of clinical decision-making in nursing has created a significant body of knowledge encompassing a range of approaches. Nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain language descriptions of nurse decision-making. Within the selected literature it is apparent that nursing prioritisation of the patient need for care is an advanced skill of nursing that is developed in practice and honed through experiential learning. |
| Call Number |
NRSNZNO @ research @ |
Serial |
661 |
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| Author |
MacGeorge, J.M.; Nelson, K. |
| Title |
The experience of the nurse at triage influences the timing of CPAP intervention |
Type |
Journal Article |
| Year |
2003 |
Publication |
Accident & Emergency Nursing |
Abbreviated Journal |
|
| Volume |
11 |
Issue |
4 |
Pages |
234-238 |
| Keywords |
Emergency nursing; Clinical decision making; Hospitals; Quality of health care |
| Abstract |
This study used a non-experimental correlational design to research the relationship between the experience of the nurse, with the application of continuous positive airway pressure therapy (CPAP) to patients presenting to a metropolitan emergency department with cardiogenic pulmonary oedema (CPO), and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within two hours, transfer to intensive care unit or cardiac care unit, and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 minutes. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses' decision-making regarding the commencement of CPAP. |
| Call Number |
NRSNZNO @ research @ |
Serial |
847 |
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| Author |
McArthur, J.; Dickinson, A.R. |
| Title |
Decision making the explicit evidence-based way: Comparing benefits, harms and costs |
Type |
Journal Article |
| Year |
1999 |
Publication |
Nursing Praxis in New Zealand |
Abbreviated Journal |
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| Volume |
14 |
Issue |
1 |
Pages |
33-42 |
| Keywords |
Evidence-based medicine; Nursing; Guidelines; Clinical decision making |
| Abstract |
This paper explores the relationship between evidence, decision tools, and the effectiveness of the nursing contribution to health services. It examines a continuum of decision-making within the international trend of the Effectiveness Movement, drawing on international literature and local experience. It draws on the concept of explicit evidence-based decision-making, the guideline development movement as exemplified through the New Zealand Guidelines Group, information technology in decision support, and the challenges of an evidential approach to nursing. This article is based on a paper given at 'The Pride and Passion of Professional Nursing Practice' College of Nurses' Aotearoa (NZ) Conference, Rotorua, 8-9 October 1998. |
| Call Number |
NRSNZNO @ research @ |
Serial |
639 |
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| Author |
McGirr, S. |
| Title |
New graduate nurses clinical decision making: A methodological challenge |
Type |
|
| Year |
2007 |
Publication |
|
Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
| Volume |
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Issue |
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Pages |
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| Keywords |
New graduate nurses; Clinical decision making; Methodology |
| 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. |
| Call Number |
NRSNZNO @ research @ |
Serial |
818 |
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| Author |
Mitchell, M.H. |
| Title |
Clinical decision-making processes in emergency nursing |
Type |
|
| Year |
2005 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
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Pages |
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| Keywords |
Emergency nursing; Education; Clinical decision making |
| Abstract |
The aim of this research paper is to explore the processes of clinical decision-making in relation to emergency nurses and to examine the educational requirements for the development of clinical decision-making skills. Clinical decision-making is foundational to professional nursing practice. It is the expectation of the profession and the organisations in which nurses work that appropriate clinical decision-making will occur. Patients also rightly expect, when being cared for by nurses, that the clinical decisions pertaining to their care will be optimal. |
| Call Number |
NRSNZNO @ research @ 592 |
Serial |
578 |
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| Author |
Paterson, J.E. |
| Title |
Nurses' clinical decision-making: The journey to advancing practice |
Type |
|
| Year |
2006 |
Publication |
|
Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
| Volume |
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Issue |
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Pages |
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| Keywords |
Clinical decision making; Mentoring; Nursing; Nurse practitioners |
| 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. |
| Call Number |
NRSNZNO @ research @ |
Serial |
681 |
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| Author |
Paterson, M. |
| Title |
Dealing with life and death decisions |
Type |
Journal Article |
| Year |
2000 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
|
| Volume |
6 |
Issue |
7 |
Pages |
14-16 |
| Keywords |
Ethics; Nursing; Patient rights; Clinical decision making; Euthanasia |
| Abstract |
This article examines the implications for nurses of not-for-resuscitation orders and orders to withdraw treatment. The rights of patients and correct procedure in the case of not-for-resuscitation or do-not-resuscitate orders are considered, as well as the ethical dilemma facing nurses in cases of the withdrawal of treatment. Guidelines are offered to assist nurses in reaching an ethical decision to withdraw treatment. Euthanasia is defined and case law decisions on not-for-resuscitation and treatment withdrawal are cited. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1017 |
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| Author |
Pirret, A.M. |
| Title |
The use of knowledge of respiratory physiology in critical care nurses' clinical decision-making |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
Massey University Library |
| Volume |
|
Issue |
|
Pages |
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| Keywords |
Intensive care nursing; Clinical decision making |
| Abstract |
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| Call Number |
NRSNZNO @ research @ 686 |
Serial |
672 |
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| Author |
Pirret, A.M. |
| Title |
The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making |
Type |
Journal Article |
| Year |
2007 |
Publication |
Intensive & Critical Care Nursing |
Abbreviated Journal |
|
| Volume |
23 |
Issue |
3 |
Pages |
145-155 |
| Keywords |
Evaluation; Intensive care nursing; Clinical decision making; Nursing; Education |
| Abstract |
The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand. Quantitative analysis showed that nurses articulated a low to medium level of knowledge of respiratory physiology. Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved. |
| Call Number |
NRSNZNO @ research @ |
Serial |
933 |
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