| Records |
| Author |
Rose, L.; Nelson, S.; Johnston, L.; Presneill, J.J. |
| Title |
Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units |
Type |
Journal Article |
| Year |
2008 |
Publication |
Journal of Clinical Nursing |
Abbreviated Journal |
|
| Volume |
17 |
Issue |
8 |
Pages  |
1035-1043 |
| Keywords |
Advanced nursing practice; Clinical decision making; Intensive care nursing; Cross-cultural comparison |
| Abstract |
The aim of this research is to provide an analysis of the scope of nursing practice and inter-professional role responsibility for ventilatory decision-making in Australian and New Zealand intensive care units (ICU). Self-administered questionnaires were sent to nurse managers of eligible ICUs within Australia and New Zealand. Survey responses were available from 54/180 ICUs. The majority (71%) were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4.7 in Australia and 4.2 in New Zealand, with 69% (IQR: 47-80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse-to-patient ratio for ventilated patients with 71% reporting a 1:2 nurse-to-patient ratio for non- ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision-making. Decisions to change ventilator settings, including FiO(2) (91%, 95% CI: 80-97), ventilator rate (65%, 95% CI: 51-77) and pressure support adjustment (57%, 95% CI: 43-71), were made independently by nurses. The authors conclude that the results of the survey suggest that, within the Australian and New Zealand context, nurses participate actively in ventilation and weaning decisions. In addition, they suggest, the results support an association between the education profile and skill-mix of nurses and the level of collaborative practice in ICU. |
| Call Number |
NRSNZNO @ research @ |
Serial |
962 |
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| Author |
Woods, M. |
| Title |
Balancing rights and duties in 'life and death' decision making involving children: A role for nurses? |
Type |
Journal Article |
| Year |
2001 |
Publication |
Nursing Ethics |
Abbreviated Journal |
|
| Volume |
8 |
Issue |
5 |
Pages |
397-408 |
| Keywords |
Parents and caregivers; Children; Ethics; Clinical decision making; Nurse-family relations; Chronically ill |
| Abstract |
This article examines a growing number of cases in New Zealand in which parents and guardians are required to make life and death ethical decisions on behalf of their seriously ill child. Increasingly, nurses and other practitioners are expected to more closely inform, involve and support the rights of parents or guardians in such situations. Differing moral and ethical values between the medical team and parents or guardians can lead to difficult decision making situations. The article analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. It concludes with a recommendation that nurses should be recognised as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1086 |
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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 |
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 |
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 |
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| 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 |
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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| Author |
Walsh, K.; Moss, C.; Lawless, J.; McKelvie, R.; Duncan, L. |
| Title |
Puzzling practice: A strategy for working with clinical practice issues |
Type |
Journal Article |
| Year |
2008 |
Publication |
International Journal of Law and Psychiatry |
Abbreviated Journal |
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| Volume |
14 |
Issue |
2 |
Pages |
94-100 |
| Keywords |
Nursing philosophy; Clinical decision making; Problem solving |
| Abstract |
The authors share the evolution of innovative ways to explore, 'unpack' and re-frame clinical issues that exist in everyday practice. The elements of these processes, which they call 'puzzling practice', and the techniques associated with them, were delineated over a two year period by the authors using action theory based processes. The authors have evolved several different frameworks for 'puzzling practice' which they draw on and use in their practice development work and in research practice. This paper pays attention to a particular form of puzzling practice that they found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues. In this example 'puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle; exploring the heart of out practice; formulating the puzzle question; visualising the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored. |
| Call Number |
NRSNZNO @ research @ |
Serial |
838 |
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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 |
| Permanent link to this record |
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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 |
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| 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 |
Paterson, M. |
| Title |
Dealing with life and death decisions |
Type |
Journal Article |
| Year |
2000 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
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| 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 |
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 |
|
| 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 |
Mitchell, M.H. |
| Title |
Clinical decision-making processes in emergency nursing |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
|
| 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 |
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 |
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 |
|
| 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 |
| Permanent link to this record |
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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 |
| Permanent link to this record |
