| Records |
| Author |
Miles, M.A.P. |
| Title |
A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001 |
Type |
|
| Year |
2005 |
Publication  |
|
Abbreviated Journal |
University of Otago Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Policy; Nursing |
| Abstract |
This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions. |
| Call Number |
NRSNZNO @ research @ 596 |
Serial |
582 |
| Permanent link to this record |
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| |
| Author |
Ross, M.E. |
| Title |
A study into the effects of the New Zealand health reforms of the 1990's on the role of the nurse manager |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
University of Otago Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nurse managers; History; Policy |
| Abstract |
|
| Call Number |
NRSNZNO @ research @ 687 |
Serial |
673 |
| Permanent link to this record |
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| |
| Author |
Mulcahy, D.M. |
| Title |
Journeys cross divides: Nurses and midwives' experiences of choosing a path following separation of the professions |
Type |
|
| Year |
2006 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Midwifery; Nursing; Policy; Careers in nursing |
| Abstract |
In 2003 the Health Practitioners Competence Assurance Act was introduced and established separate regulatory authorities for nursing and midwifery. This study is designed to explore the experiences of dually registered practitioners affected by this divide, as now there are two separate and possible paths, and two corresponding sets of competencies to fulfil. The design for this qualitative descriptive study utilised the written and oral narratives of three practitioners affected by this professional regulation and demonstrated its impact on their career development. Individual storytelling, as narrative, provided a theoretical lens aiding insight into their experience and pattern of decision making. In addition, symbolic consideration of the study data was provided by collective storytelling via the perennial myth of the hero journey. Shifting professional ground following the Health Practitioners Competence Act 2003 generated a focus for the inquiry into practitioners' modes of adjustment. For the practitioners in the study, transition between the occupational roles of nursing and midwifery comprised the possible career trajectories. A status passage, as the process of change from one social status to another, is described and includes the transitional experience of anticipation, expectation, contrast, and change. The author suggests that the findings from this research provide illumination of the nuances of professional decision making as a lived experience, and highlight how these practitioners dealt with shifting meaning, values, awareness, choices, and relationships. Aspects of group agency and identity, change management, and professional role transition were revealed. Life pattern, revealed through narrative, was an important research construct for exposing the ways in which the participants negotiated change, and displayed the function of their thinking and reasoning through dilemmas. Perception of individual and group identity revealed attitudes of esteem to the dominant discourse, and exposed dynamic tension between work patterns and life stage. Renegotiating arrangements of personal and professional commitment resulted from this dynamic interplay, and the relationship to stress and burnout was explored. |
| Call Number |
NRSNZNO @ research @ 700 |
Serial |
686 |
| Permanent link to this record |
| |
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| |
| Author |
Stuart, J. |
| Title |
How can nurses address generalist/specialist/nursing requirements of the urban/rural population of Southland |
Type |
|
| Year |
2003 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nursing specialties; Policy; Technology; Scope of practice; Community health nursing |
| Abstract |
This study, which is undertaken in the Southland area, explores the effect of the increasing specialisation of nursing services in what is a rural/urban environment. It is indicated in the literature that systemic changes in health, such as the health reforms, and the increase in the use of technology have meant that nurses are required to function in disease oriented roles rather than according to their more traditional generalist roots. A significant event, which also affected nursing scope of practice, was the transfer of nurse education to the tertiary education institutions environment from the hospitals in the mid 1970s. The traditional nursing hierarchy and its nurse leadership role disappeared and the adoption of specialist nurse titles increased, and identified with a disease or disorder, for example 'diabetes' nurse. The increase in specialist categories for patients contributed to the nurse shortage by reducing the available numbers of nurses in the generalist nursing pool. The nurses in this rural/urban environment require generalist nurse skills to deliver their nursing services because of the geographical vastness of the area being a barrier to specialist nurses. Workforce planning for nurses in the rural/urban then must focus on how to reshape the nursing scope of practice to utilise the existing resources. This study explores how key areas of health services could be enhanced by reclaiming the nurse role in its holistic approach, in mental health, public health, geriatric services and psychiatric services. |
| Call Number |
NRSNZNO @ research @ 885 |
Serial |
869 |
| Permanent link to this record |
| |
|
| |
| Author |
Miles, M.A.P. |
| Title |
A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001 |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
NZNO Library, University of Otago Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Primary health care; Interprofessional relations; Policy |
| Abstract |
This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions. |
| Call Number |
NRSNZNO @ research @ 1146 |
Serial |
1131 |
| Permanent link to this record |
| |
|
| |
| Author |
Bleach, A. |
| Title |
Nurses talk the walk: An exploration of nurses' perception of advanced nursing practice on acute mental health inpatient units in New Zealand |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Mental health; Nursing; Policy; Registered nurses; Advanced nursing practice; Psychiatric Nursing |
| Abstract |
The last twenty years, particularly the early 1990s, ushered in major mental health sector reforms inclusive of deinstitutionalisation policies and subsequent development of community services. Concurrent changes to student nurses' education left registered nurses as the workforce mainstay on inpatient units. However, the author suggests, an emerging global shortage of nurses and implementation of the Employment Contracts Act (1991) negatively impacted on recruitment and retention of registered nurses. Inpatient nurses either left nursing or moved to community positions for better money and increased job status. The author suggests that, as a consequence, the 'critical mass' of experienced and skilled nurses who traditionally provided nursing leadership disappeared resulting in compromised standards of care for patients. As the manager of an inpatient unit, the author proposed the establishment of advanced nursing practice roles as one initiative to provide nursing leadership in order to attract and retain nurses. This study explored five inpatient nurses' perceptions of advanced practice and whether these roles could assist to provide leadership and improve standards of care. The research was a qualitative exploratory descriptive study using a focus group interview as the data collection method. A thematic analysis of the group discussion transcription revealed three key themes: 1) the 'makeup' of advanced nursing practice, 2) moving forwards: establishing roles, 3) moving sideways: barriers to role development. The themes are critically discussed in relation to selected literature. The thesis includes recommendations that could be used by nurses responsible for planning and implementing advanced practice roles on inpatient units. |
| Call Number |
NRSNZNO @ research @ |
Serial |
663 |
| Permanent link to this record |
| |
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| |
| Author |
Jacobs, S. |
| Title |
Advanced nursing practice and the nurse practitioner: New Zealand nursing's professional project in the late 20th century |
Type |
|
| Year |
2005 |
Publication |
|
Abbreviated Journal |
Massey University Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nurse practitioners; History; Policy; Leadership; Advanced nursing practice |
| Abstract |
This thesis examines the forces influencing the development of contemporary advanced nursing practice in New Zealand. It begins with an historical approach to explore the various meanings of advanced nursing practice from the late 1800s through the first years of the 21st century. Seven historical understandings of the meaning of 'advanced' nursing practice emerge. The author's analysis of the broad scope of New Zealand nursing history, including a case study of the development and implementation of the nurse practitioner, draws on theoretical perspectives from sociology, political science, and nursing. She develops a “framework of critical factors for nursing to take into account when considering how to ensure the profession is able to deliver on its great potential to improve the health of New Zealand communities”. Examining the work of a range of nursing leaders, past and present, and drawing on the work of political scientist, John Kingdon, the author describes the work of several nurses as “policy entrepreneurship.” |
| Call Number |
NRSNZNO @ research @ |
Serial |
671 |
| Permanent link to this record |
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| |
| Author |
Watson, S.L. |
| Title |
Attitudinal shifting: A grounded theory of health promotion in coronary care |
Type |
|
| Year |
2007 |
Publication |
|
Abbreviated Journal |
AUT University Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Health promotion; Policy; Professional development; Cardiovascular diseases; Nursing; Nurse-patient relations; Education |
| Abstract |
Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities. |
| Call Number |
NRSNZNO @ research @ |
Serial |
807 |
| Permanent link to this record |
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| Author |
Bailey, A.M. |
| Title |
The New Zealand practice nurse in the primary health environment of the 21st century |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Victoria University of Wellington Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Policy; Practice nurses; Primary health care |
| Abstract |
This paper is a culmination of the author's inquiry, reflection and critical thinking on the transitional phase that practice nursing is currently undergoing as part of the New Zealand Primary Health Strategy. The paper utilises both reflection-in-action and reflection-on-action as well as reflection-before-action, as a process. The author's starting point for this inquiry was attending the New Zealand Nurses Organisation Primary Health Conference in Wellington and reading a report from the Expert Advisory Group on Primary Health Care Nursing. Knowing that practice nurses are the majority of nurses working in primary health, she was concerned that changes to primary health were being driven with little reference or participation by them. The paper explores how practice nursing evolved in New Zealand and the developments that have occurred in the 30 plus years since its inception. It describes the role and current work of practice nursing in general practice, and highlights the constraints that have held back development and continue to do so. The 2002 New Zealand Primary Health Strategy is shown to provide an opportunity for development and enhancement, if some of the constraints are removed. As part of looking to the future the possibilities for practice nurses to lead the way in primary health development are explored. |
| Call Number |
NRSNZNO @ research @ |
Serial |
831 |
| Permanent link to this record |
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| |
| Author |
Hamer, H.P.; Finlayson, M.; Thom, K.; Hughes, F.; Tomkins, S. |
| Title |
Mental health nursing and its future: A discussion framework: Report from the Expert Reference Group to the Deputy Director-General Dr Janice Wilson |
Type |
Report |
| Year |
2006 |
Publication |
|
Abbreviated Journal |
|
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Mental health; Psychiatric Nursing; Policy; Leadership; Nurse practitioners; Nursing; Education; Careers in nursing |
| Abstract |
This project was initiated by the Ministry of Health to ensure a nationally coordinated approach to mental health nursing. The purpose of the project is to provide a national strategic framework for mental health nursing that will strengthen both nursing leadership and practice within the multi-disciplinary clinical environment. The framework reviews a range of key workforce issues identified by the Ministry of Health and provides strategies to move mental health nursing forward. The framework integrates directions from government mental health strategies, policies and directions, national and international literature as well as professional nursing requirements which aim to create a sustainable mental health nursing workforce using evidence based practice. The framework considers a range of key workforce issues identified by the Ministry of Health including: nursing leadership, nurse practitioners, standards, skill mix, clinical career pathways, professional supervision, education, research and recruitment and retention. |
| Call Number |
NRSNZNO @ research @ |
Serial |
865 |
| Permanent link to this record |
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| Author |
Honeyfield, Margy |
| Title |
The necessity of effective nursing leadership for the retention of professional hospital nurses |
Type |
|
| Year |
2008 |
Publication |
|
Abbreviated Journal |
Otago Polytechnic library. A copy can be obtained by contacting pgnursadmin@tekotago.ac.nz |
| Volume |
|
Issue |
|
Pages |
64 |
| Keywords |
Recruitment and retention; Leadership; Nursing; Policy |
| Abstract |
The author notes that it is widely accepted that there is a global shortage of nurses, and there are many studies in the health workforce literature about the negative aspects of nurse work environments, nursing workloads, decreased job satisfaction of nurses and the impact these have on patient health outcomes. In the past five years there has also been international and New Zealand-specific research into the effects of health restructuring on nursing leadership, retention of nurses, and on patient care. Much of this research has shown that countries with very different health care systems have similar problems, not only with retention of qualified nursing staff due to high levels of job dissatisfaction, but also with work design and the provision of good quality patient care in hospitals. This dissertation explores the many detrimental effects on nurses and nursing leadership, of extensive, and continuing, public health restructuring in New Zealand. The context of this dissertation is New Zealand public hospitals, with references pertaining to medical and surgical areas of nursing practice. Health reforms have negatively impacted on patient care delivery systems, patient health outcomes, and retention of educated nurses in the workforce. In order to resolve these issues, coordinated efforts are required in New Zealand district health boards to develop and sustain effective nursing leaders, who will promote and assist in the development of strong, healthy organisational cultures to retain and support professional nurses and the ways in which they wish to practise. |
| Call Number |
NRSNZNO @ research @ |
Serial |
868 |
| Permanent link to this record |
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| Author |
Mackay, B. |
| Title |
An analysis of innovative roles in primary health care nursing |
Type |
|
| Year |
2004 |
Publication |
|
Abbreviated Journal |
Northland Polytechnic Library |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nurse practitioners; Primary health care; Maori; Policy; Careers in nursing |
| Abstract |
An analytical tool of Force Field Analysis was used to identify and describe forces influencing the development of innovative roles, including the nurse practitioner role, in primary health care nursing. At the commencement of the study an initial analysis of research, literature and policy identified forces driving or restraining the development of innovative roles. A mixed research method of surveys and focus group interviews with key stakeholders, namely nurses in innovative roles, general practitioners and nurse leaders, was then used to identify factors influencing development within the Northland District Health Board. Descriptive statistics and interpretative methods were used to analyse the data. A final analysis enabled a picture of forces influencing innovative role development to be presented. Driving forces reflected international trends and were strongly influenced by economics and a political imperative to reconfigure health care services towards a primary health focus. The Treaty of Waitangi was also a key influence. Driving forces had greatest impact on the development of new roles. Forces were identified as drives towards cost-effective evidence-based health care (effective services), equity for Maori, response to local needs and workforce reorganisation. The major forces restraining the development of innovative roles were reinforced by attitudes, customs and support systems. These forces were identified as poor professional identity and support, an outdated nursing image, inadequate education and training and slow transition from traditional practices and structures (tradition). These forces had a negative influence on support for innovative roles. Promotion of kaupapa Maori, involvement of the local community, local Maori and nursing in decision-making and promotion of a team culture have the potential to support further development of innovative roles. Political ideology and the Treaty of Waitangi will continue to be major influences directed through policy and the contracting and funding process. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1124 |
| Permanent link to this record |
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| Author |
Casey, H. |
| Title |
Empowerment: What can nurse leaders do to encourage an empowering environment for nurses working in the mental health area |
Type |
|
| Year |
2000 |
Publication |
|
Abbreviated Journal |
ResearchArchive@Victoria |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Policy; Leadership; Careers in nursing; Mental health; Psychiatric nursing |
| Abstract |
For nurses to have control over their practice they need to have input into policy development. Nurses having control over their practice has been linked to nursing empowerment. Therefore the question explored in this research project is: What can nurse leaders do to encourage an empowering environment for nurses working in the mental health area? The literature reviewed for this project includes empowerment, power, the history of nursing in relation to women's role in society, oppression and resistance, and literature on Critical Social Theory as the underlying theoretical and philosophical position which informs the research process. In order to answer the research question a single focus group was used to gather data from a group of registered nurses practising in mental health. Focus groups as a data collection method produce data and insights that would be less accessible without the interaction found in the group. The key themes to emerge from the data analysis were: power is an important component of empowerment and power relationships; and at a systems level, professional, organisational, and political influences impact on feelings of empowerment and/or disempowerment. These key themes are discussed in relation to the literature and the broader social and cultural context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations for nurse leaders who aim to provide an empowering environment for nurses practising in mental health. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1145 |
| Permanent link to this record |
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| Author |
Litchfield, M. |
| Title |
A framework of complementary models of nursing practice: A study of nursing roles and practice for a new era of healthcare provision in New Zealand |
Type |
Report |
| Year |
2001 |
Publication |
|
Abbreviated Journal |
Online on the Ministry of Health's Centre for Rural Health pages |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Nursing models; Rural nursing; Policy; Scope of practice |
| Abstract |
This is the second of a series of research projects undertaken to present the contemporary picture of the nurse workforce and their work in rural settings to inform policy for development of rural healthcare. The document presents the findings of telephone interviews with nurses in different work rural work settings around the country discussing their practice. The analysis identified a framework of four models of nursing practice: two traditional models defined by the institutions employing nurses, and two emerging models defined by the new positions requiring nurses to respond directly to health need. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1176 |
| Permanent link to this record |
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| Author |
Clissold, C. |
| Title |
How discourses stifle the Primary Health Care Strategy's intent to reduce health inequalities |
Type |
|
| Year |
2006 |
Publication |
|
Abbreviated Journal |
ResearchArchive@Victoria |
| Volume |
|
Issue |
|
Pages |
|
| Keywords |
Community health nursing; Policy; Primary health care |
| Abstract |
The Primary Health Care Strategy (PHCS) has a stated commitment to defined populations who suffer disproportionately from ill health. This thesis examines whether some prevailing discourses actually decrease the focus on health inequalities. A study of the nursing and medical media found that it focused predominantly on professional and industrial issues, leaving health workers focused mainly on their own professional interests, rather than considering the effects on health inequalities. She goes on to suggest that current Ministry of Health discourse values decentralised community health decision making. This may gloss over factors in community health which are affected by Government policy such as employment policy, and thus should be dealt with centrally by legislation. These factors have been found to be the most pertinent in health inequalities. So while models of community partnerships may seem to place communities as agents in their own health, this downplays the determinants of health which are beyond their control. Having shown that discourse can decrease the focus on health inequalities due to other professional and political drivers, the author then looked at health initiative concepts which are effective, efficient and equitable given the current set up of PHOs and nursing innovations. |
| Call Number |
NRSNZNO @ research @ |
Serial |
1196 |
| Permanent link to this record |
