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Author |
Smillie, A. |
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Title |
The end of tranquillity? An exploration of some organisational and societal factors that generated discord upon the introduction of trained nurses into New Zealand hospitals, 1885-1914 |
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Year |
2003 |
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Abbreviated Journal  |
Victoria University of Wellington Library |
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Keywords |
History; Nursing |
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Abstract |
This historical research study examines some of the factors that caused problems for early New Zealand trained nurses upon their introduction into New Zealand hospitals, between 1885 and 1914. Eight incidents in the professional lives of nurses of the period are used as illustrations of the strains and discord that were apparent in this time of change. Analysis of these incidents attempts to answer the question as to whether the introduction of trained nurses into the New Zealand hospital system did add new considerations to problems encountered by nurses in their professional life. The conclusion is that there was a new dimension of difference added to the system with the introduction of the trained nurse. This developed from the evidence that these nurses, particularly if they were also matrons, had to fit into the existing power structures, which were not really ready to accept them, either through choice or lack of foresight. Enmeshed within these considerations is the influence of Florence Nightingale; her effect on nursing itself, and the consequent public and official perception, or misperception, of who nurses should be. |
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NRSNZNO @ research @ |
Serial |
857 |
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Author |
Bresaz, D.M. |
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Title |
Environmental influences on inpatient assaultive behaviour |
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Year |
2003 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Keywords |
Workplace violence; Mental health; Psychiatric Nursing; Methodology; Administration |
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Abstract |
This retrospective quasi-experimental study reviewed assaults in two adult mental health inpatient rehabilitation units. The majority of clients in this area experience enduring mental health illnesses and have complex physical health issues. The service comprises of an intensive rehabilitation unit and a secure extended rehabilitation unit. Between May and August 2001 the service moved to purpose built facilities. The opportunity was taken to review clients' assaultive behaviour in the new environment and to compare the incidents with those in the old environment to see if there had been any significant changes. Data on assault incidents including time of assault, place of assault, who was involved and what preventative actions were suggested were collected from the Incident and Accident Hazard Reports (IAHR) dating from 1 April 2000 until 31 May 2002. Staff were expected to complete IAHR reports on all assault incidents. The research examined whether the change in environmental conditions impacted on clients' wellbeing in relation to assaultive behaviour. Trends within the IAHR reports were also examined in order to compare these to similar studies completed in other parts of the world. There were 141 IAHR reports of assault incidents. Fifty of these occurred in the pre move period, 38 in the transition phase and 53 in the post move. There was no significant difference in the rate of assaults in the pre-move to post move period. Completion of the IAHR forms was seen to be very problematic, especially in relation to legal status of perpetrators and documentation of prevention strategies. An urgent audit of existing practice is now required to establish if problems found with the quality and completion of the IAHR forms continues to be evident in the rehabilitation service and if present staff education is needed to improve the standard of documentation. Research is also needed to establish the extent to which staff implement strategies to prevent assaults, and to reduce recidivism. |
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Call Number |
NRSNZNO @ research @ |
Serial |
858 |
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Author |
Laracy, K. |
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Title |
Exploration of the self: The journey of one pakeha cultural safety nurse educator |
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Year |
2003 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Keywords |
Cultural safety; Teaching methods; Nursing; Education; Professional development; Transcultural nursing; Maori; Identity |
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Abstract |
Cultural safety is taught in all undergraduate nursing programmes in Aotearoa/New Zealand. There is a predominance of Pakeha nurse educators in teaching this content. There is little explanation of what being Pakeha entails. This perpetuates a silence and continues the dominant hegemonic position of Pakeha in Aotearoa/New Zealand. This study suggests that as Pakeha cultural safety nurse educators we examine our dominance and critique the delivery of cultural safety education. This autobiographical study undertakes to explore the Pakeha identity of a cultural safety nurse educator. The author discusses identity in the context of a globalised world, and challenges the idea of a definitive Pakeha identity. There are multiple descriptions of Pakeha, all underdeveloped and inadequate for the purposes of cultural safety education. In this study, the author uses the heuristic process of Moustakas (1990) and Maalouf's (2000) ideas of vertical and horizontal heritage to locate and present the essence of the self. In keeping with the purpose of cultural safety education, the author considers her ethnic cultural self as described by Bloch (1983) and explores Helms' (1990) theory of White racial identity development. This thesis describes the position of one Pakeha in the context of teaching cultural safety in an undergraduate nursing degree programme in Aotearoa/New Zealand. For Pakeha cultural safety nurse educators the author argues that exploration of one's heritages and location of a personal Pakeha identity is pivotal to progressing the enactment of cultural safety in Aotearoa /New Zealand. |
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Call Number |
NRSNZNO @ research @ |
Serial |
864 |
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Author |
Radka, I.M. |
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Title |
Handover and the consumer voice: The importance of knowing the whole, full story |
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Year |
2003 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Issue |
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Keywords |
Communication; Patient satisfaction; Nurse-patient relations |
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Abstract |
In the acute hospital setting, nurses provide care twenty-four hours a day, seven days a week. Due to the ever-changing nature of the patient's situation, nurses need quality information at the beginning of each eight-hour shift to plan and implement patient care effectively. It is claimed that handover is central for maintaining the continuity and the quality of patient care. This qualitative descriptive study was undertaken to identify what core information needs to be exchanged at nursing handover to ensure quality and continuity of patient care. Five consumers who had experience of recurrent hospital admissions shared their perceptions of handover practice through individual interviews. Three focus group meetings of seven nurses from a secondary care setting discussed handover practice from their professional perspectives. Both nursing and consumer voices are integral to the overall understanding of this study but the consumer voice is the privileged and dominant voice. Through the process of thematic content analysis the central themes of communication, continuity and competence emerged for the consumers. Consumers expect to be kept informed and involved in their healthcare. They want continuity of nurse, information and care and expect that nurses involved in the delivery of healthcare are competent to manage their situation. The 'importance of knowing' is the overarching construct generated in this research. Knowing is identified as the foundation on which quality and continuity of care is built and is discussed under the subheadings of: not knowing, knowing the patient as a person, knowing takes time, hidden knowing, knowing consumers' rights, oral knowing, knowing involves more than handing over patient care and knowing the economics. Recommendations have been developed for future research, nursing practice, education and management. These centre on ways to develop a more consumer-focused approach to contemporary healthcare. |
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Call Number |
NRSNZNO @ research @ 883 |
Serial |
867 |
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Author |
Stuart, J. |
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Title |
How can nurses address generalist/specialist/nursing requirements of the urban/rural population of Southland |
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Year |
2003 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Pages |
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Keywords |
Nursing specialties; Policy; Technology; Scope of practice; Community health nursing |
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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. |
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Call Number |
NRSNZNO @ research @ 885 |
Serial |
869 |
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Author |
Love, E. |
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Title |
Towards the best of both worlds: Developing a partnership between education and practice to improve clinical practicum experience and learning outcomes for undergraduate nursing students |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Issue |
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Pages |
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Keywords |
Nursing; Education; Teaching methods |
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Abstract |
One proposed method for addressing concerns about a `theory-practice gap' in nurse education and perceived clinical shortcomings in beginning practitioners, is improved collaboration between education and practice. This paper is about a New Zealand nursing initiative to promote optimal learning outcomes for nursing students through supported hospital clinical experiences. It is implemented through a contractual partnership between Lakeland Health Limited in Rotorua, and Waiariki Institute of Technology. An associated “Clinical Nurse Educator Programme”, developed by lecturers at Waiariki's nursing school, prepares hospital nurses to be Clinical Nurse Educators. These “C.N.Es” replace and enhance the clinical role formerly provided by nursing lecturers, and short term contracted nurses. The programme is entering its fourth year with positive evaluations, and has extended into another hospital. Literature suggests that although educators are important, students may consider hospital nurses much more significant for their clinical learning and developing confidence 'in the real world'. These nurses are on hand, and generally have clinical credibility not afforded to academic staff. However, ward nurses, like contracted nurse teachers, have reported not having enough curriculum knowledge, nor teaching skills to optimise student learning. This C.N.E programme addresses these shortcomings through its selection of experienced nurses in current practice, and 50 hours of theoretical and practical course content, to prepare them for the role. This paper provides a clinical and personal perspective of the C.N.E programme, its beginnings, how it works locally, and process for its ongoing development. Not only does this programme provide a bridge between theory and practice for students during their clinical practicum placements, but communication, consultation and collaboration between education, practice and the workplace have also improved. Nurses in both sectors are confident that through the developing partnerships, students and future practice will benefit from the aim to provide students with 'the best of both worlds'. |
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Call Number |
NRSNZNO @ research @ |
Serial |
897 |
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Author |
Wilson, H.V. |
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Title |
Surveillance or support: Divergent discourses in Plunket nursing practice |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Issue |
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Pages |
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Keywords |
Public health; Children; Community health nursing; Plunket |
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Abstract |
Plunket nurses are New Zealand child health nurses who work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices which are generally carried out in homes and clinics in the context of a relationship with the child's mother (Ministry of Health 1996; Royal New Zealand Plunket Society 1997). However, evidence in the literature that surveillance can have implications for power relations throws doubts on official claims that the relationship between the mother and nurse operates as a partnership (Trout and Polaschek 1996). The purpose of this thesis was to explore the way in which surveillance is constituted within the discourses of Plunket nurses and to examine these discourses for any implications of unequal power relations. Foucauldian discourse theory and poststructuralism, which informed this thesis, provided the opportunity to challenge assumptions about power and knowledge in the child health context. Analysis of the discourses generated by interviews with five Plunket nurses revealed that, contrary to the claims in the official literature, the relationship between the Plunket nurse and the mother is not that of an equal partnership but is constituted in various and unexpected ways. It was through the nurses' discourses of surveillance that the power relations underpinning this relationship were surfaced. While these discourses suggested that many mothers who use the nursing service are actively involved on their own terms, there are a number of women for whom the surveillance activities of the nurse have been shown to be particularly intrusive (Mayall 1986; Clinton 1988; Bloor and McIntosh 1990; Knott and Latter 1999). It may be primarily this unwelcome surveillance which accounts for the considerable number of women who, the statistics show, cease using Plunket services particularly in the early months. It is perhaps for this reason that the nurses in this study locate themselves as being caught between divergent discourses of support and surveillance. Findings indicate that the resolution of this dilemma by abandoning surveillance practices might improve maternal satisfaction with the Plunket nursing service. The author concludes that a child health service responsive to mothers' stated needs rather than institutional requirements or the nurse's own agenda could lead to a more open and equal relationship between mother and nurse. This relationship would be likely to benefit mothers and babies and, at the same time, enhance both nursing practice and nurses' satisfaction with their work. |
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Call Number |
NRSNZNO @ research @ |
Serial |
899 |
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Author |
Brinkman, A. |
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Title |
A study into the causes and effects of occupational stress in a regional women's health service |
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Year |
2000 |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Pages |
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Keywords |
Stress; Midwifery; Nursing |
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Abstract |
Hospital-based health systems have the potential to be high stress environments, as staff work towards meetings the many and varied demands of the patients and their families / whanau in a situation of limited resources and unpredictable workloads. Dealing with physical and emotional trauma, and the 'normal' exigencies of daily life in what may be a far from normal workplace may compound the stresses facing health workers. Nurses, who are often at the interface between patients and other health professionals, may be caught in a cross-fire of transferred stress while also coping with stressors associated with their jobs. As well as being likely to have a negative effect on their well-being and job satisfaction, any such compounding impact of stress and stressors could have adverse impacts on patients and their supporters. The primary focus of this study has been to identify stress levels among nurses in a woman's health service, and to establish the causes of elevated stress. All staff were surveyed (with a 68% response rate). Midwives made up the largest portion, followed by nurses, doctors, therapies, support and clerical groups. The Job Stress Survey (JSS) and the General Health Questionnaire – 12 (GHQ-12) were used to help detect emergent stressors, and stress effects that staff were experiencing at the time. Aggregate data was used, focusing on the six occupational groupings and the nine areas within the health service. Findings from the JSS confirm that the staff had experienced a number of stressors, while indications of deleterious mental health effects in some staff emerged from the GHQ-12 scores. Occupational stress is a subset of general stress, making it difficult to separate one from the other as spheres of our lives overlap and interact. The stressors that were identified should contribute to the discussions and policies that might abet the reduction of stress. On the other hand, it is not possible to attribute the effects describes by the GHQ-12 as being derived primarily from occupational stress. A stressed staff member, no matter what the source of their stress might be, still needs support in order to cope. The author notes that the negative outcomes of occupational stress manifests themselves in many ways such as; mistakes, absenteeism, horizontal violence, burnout and turnover. These all affect the quality of the patient care delivered, leading to decreased patient satisfaction and and need to be addressed for these reasons. |
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Call Number |
NRSNZNO @ research @ |
Serial |
900 |
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Author |
de Carlo Ahuarangi, K. |
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Title |
Hei watea taupuhipuhi: The space of symbiosis: A conceptual framework for nursing practice |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Maori; Teaching methods; Nursing; Transcultural nursing |
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Abstract |
Te watea taupuhipuhi, the space of symbiosis is a framework for nursing practice. It examines the notion of the nursing presence as holding continuity and multiplicity of viewpoint in space of symbiosis. The author developed a teaching-learning situation as an introduction of key ideas in his work where the Maori word “ako” becomes the catalyst of a particular pedagogy that outlines the central notions of symbiosis. Thus, he notes, his work realises that symbiosis occurs not only on the clinical arena of nursing but in the teaching – learning environment as well, his own space of symbiosis. Four rites of passage coalesce a totality of experience within the space of symbiosis, revealing that the central role of the nursing presence is to surface meaning and sense for all of experience which can be fearful, mysterious, paradoxical and chaotic. These four rites of passage are described as the interpretive, integrative, transformations and transcendent. The twelve dynamics of nursing from the axle around which a praxis of nursing revolves. An analysis of those twelve dynamics in rite of passage is situated within narratives taken from the author's nursing practice. He also draws extensively from Maori ontology and autobiography in positioning his exposition within this local context. |
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Call Number |
NRSNZNO @ research @ |
Serial |
901 |
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Author |
Maddocks, W.A. |
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Title |
Soft tissue massage in nursing practice: An analysis |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Alternative therapies; Nursing |
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Abstract |
The use of massage by nurses is a popular activity in many fields of nursing practice. The last ten to fifteen years have seen a rising popularity in the literature. Whilst the literature within nursing is plentiful it often does not present the empirical evidence necessary to support nursing actions. The objective of this analysis is to present the extant literature discussing soft tissue massage from a Western health perspective. Massage has first been contextualised as an ancient as well as modern healing activity. There is evidence of early modern medical interest in the therapeutic benefits of massage for a number of ailments. From this contextual perspective it is then possible to track the evolution of modern complementary health practices since 1980, and the professional and practical issues surrounding their use. Against the backdrop of twenty-first century health care there is increased evidence of the importance of maintaining the human aspect of caring, and massage is seen as an ideal way to provide this. The author argues that the discipline of modern nursing must increase its awareness of the empirical evidence around the use of massage, to provide safe and effective nursing care. This physiological and psychological evidence is presented and critiqued, based on the principles of evidence-based practice. This critique has enabled some sound research-based practical statements on the effects of massage to be made. These statements will enhance the practice of massage within a nursing context. The final part of the journey has been to explore the actual practice of massage within nursing, including the current use of massage by a sample of New Zealand nurses. The educational opportunities have also been presented, alongside some main professional issues. Massage can now be viewed as a legitimate nursing tool that has value in a range of nursing settings by enhancing the quality of patient care. The techniques are easy to learn, simple to perform and do not add undue workload to nurses. The author notes that there is a considerable amount of literature to support this, but the quest for further knowledge cannot be ignored. |
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Call Number |
NRSNZNO @ research @ |
Serial |
902 |
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Author |
Wilson, S.K. |
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Title |
Reconstructing nurse learning using computer mediated communication (CMC) technologies: An exploration of ideas |
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Year |
2003 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Computers; Technology; Nursing; Education |
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Abstract |
Computerised technology has become a way of life. As nurse graduates enter a computer driven health care system we have a responsibility as nurse educators to ensure that they are computer familiar as borne out by the recent discussion papers released by the Nursing Council of New Zealand (2000a), which define the requirements for the practitioner of the future. Concurrently there is a call from the discipline of nursing for practitioners who have a form of knowledge that will bring about change within the socio-political context of the discipline as an outcome of critically reflective knowledge skills. Jurgen Habermas' (1971) treatise on knowledge and human interests, which offers a multi-paradigmatic approach to three forms of knowledge culminating in the emancipatory form provides a conceptual framework for many under-graduate pre-registration nursing curricular in Aotearoa-New Zealand. This thesis explores the author's ideas about contemporary undergraduate pre-registration nursing preparation in Aotearoa-New Zealand, associated knowledge outcomes, and the consequent links with contemporary computer-mediated communication (CMC) technologies. It positions a framework for integrating CMC technologies and the action of critically reflective practice as a learning journey. The framework is hypothetical and pragmatic. It emerges from the exploration of the thesis and is posited as a way toward integrating CMC technologies within extant undergraduate pre-registration nursing curricular in Aotearoa-New Zealand. The learning journey is comprised of three dimensions, learning-for-practice, learning-from-practice and learning-with-practice and draws on four different cyber constructs: being, knowing, relating and dialoguing. Knowing, relating and dialoguing are ontological positions taken in relation to being. The learning journey sustains some derivation from Habermasian (1971) based conceptual framework. There is a need for nurse educators to consider this in relation to contemporary CMC technologies. The author hope that this framework will serve those with an interest in nurse education and who are interested in a future using CMC technologies within the realities of nursing practice and education. |
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Call Number |
NRSNZNO @ research @ |
Serial |
904 |
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Author |
Williams, B.G. |
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Title |
The primacy of the nurse in New Zealand 1960s-1990s: Attitudes, beliefs and responses over time |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing; History; Registered nurses |
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Abstract |
Exploring the past, and pulling ideas through to the present, to inform the future can make a valuable contribution to nurses and nursing in New Zealand. By gaining some understanding of the attitudes and beliefs nurses held, and how these influenced their responsiveness, we can learn what active responses might help inform our future. Nurses in New Zealand, as individuals and within the profession as a whole, reveal the primacy of the nurse – nurses who have made and can continue to make a difference to the health of the peoples of New Zealand. A hermeneutic process was used to interpret material, from international texts, national texts and public records over four decades, the 1960s to 1990s. This was supplemented and contrasted with material from twelve oral history participants. Analysis of the material led to the emergence of four themes: Nurses' decision-making: changes over time; An emerging understanding of autonomy and accountability; Nurses as a driving force; and Creating a nursing future. These four themes revealed an overall pattern of attitudes, beliefs and responses of the New Zealand registered nurse. The themes surfaced major revelations about the primacy of the nurse in New Zealand, nurses confident in their ability to take the opportunity, seize the moment, and effect change. The author suggests that the contribution this thesis makes to the discipline of nursing is an understanding of how the nurse actively constructs the scope of a professional response to the context. The author notes that the thesis demonstrates how nurses can learn from the past, that the attitudes and beliefs that underpin our active responses can either move us forward, or retard our progress. As nurses we can also learn that to move forward we need particular attitudes, beliefs and responses, that these are identifiable, and are key factors influencing our future, thus ensuring the continued primacy of the nurse. |
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Call Number |
NRSNZNO @ research @ |
Serial |
905 |
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Author |
Harker, D.Y. |
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Title |
Nurses as patients: The stories of two woman nurse educators as recipients of nursing care |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing; Education; Preceptorship; Feminist critique |
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Abstract |
In this research two nurse-patients have engaged in a conversation about their experience of 'being nursed'. The project sets out to address the following questions: How might our experiences as nurses who have been hospitalised be drawn upon to influence positive changes in nursing practice? What effect might our experiences of hospitalisation have on us as nurses and on our nursing practice? The study utilises narrative as inquiry and the method of story telling and auto/biography to tell the stories of Maria (a pseudonym) and the researcher herself. This interpretive research has been informed by the feminist process and sits within a postmodern framework. Maria's stories were audio taped and transcribed before being prepared for analysis using 'core story creation', and the process of 'emplotment' (Emden, 1998b). The author's reflective topical autobiographical narrative was constructed through the processes described by Johnstone (1999). Three distinct qualities emerged from both experiences. The first, 'knowing as nurse-patient' contains the three sub-themes of 'having knowledge', 'expectations of being nursed', and 'knowledge gained'. The second distinct quality 'being nursed' contains the two sub-themes of 'feeling safe and cared for' and 'presencing'; and the third, 'not being nursed', contains the four sub themes 'feeling vulnerable', 'invisibility of nurses', 'getting out' and 'feeling let down'. The sub-theme 'getting out' includes three additional sub themes of 'wanting to get out and not wanting to be there', 'leaving and the need for closure' and 'not wanting to go back'. The author notes that nursing does make a difference to patient care. However, for patients to receive therapeutic care, new graduate nurses must be preceptored/mentored by experienced nurses in supportive programmes. Suggestions for further research have been identified. |
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Call Number |
NRSNZNO @ research @ |
Serial |
907 |
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Author |
Rose, A. |
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Title |
Is case management an efficient and effective model of care for complex patients in an acute medical setting? |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Clinical decision making; Culture; Nursing; Quality assurance |
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Abstract |
This thesis looks at the prospect of developing and implementing case management as a model of care for complex patients in an acute medical setting. An extensive literature review was conducted to explore the concept of case management and to identify the role of the case manager, including the qualities and qualifications required for the position. Clinical pathways are a tool used in case management so these are also included in the literature review. As the author had been involved in the development of the first clinical pathway for Hutt Valley Health, this is used as an example to clarify how case management and clinical pathways can be used in conjunction. A discussion chapter examines the advantages and disadvantages of case management which shows that it can be an effective and efficient model of care through the development of clinical pathways. The ethical implications of case management are also considered. The thesis concludes with recommendations for the continued development of case management as a model of care to improve the quality of care for both patients and the organisation. During the course of the thesis, other areas that are worth further investigation have also been identified, such as the relevance of case management to different cultures. The thesis suggests that a proposal for case management for complex patients in the acute care setting is developed along with a job description for the role of the case manager. |
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Call Number |
NRSNZNO @ research @ |
Serial |
908 |
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Author |
Strochnetter, K.T. |
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Title |
Influences on nurses' pain management practices within institutions: A constructivist approach |
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Year |
2000 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Interprofessional relations; Pain management; Nursing |
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Abstract |
Alleviating patient suffering, providing comfort and pain relief are all central to the philosophical caring position nurses have always espoused. Despite this, patients continue to suffer pain although we have the means to provide pain relief. The author notes that research has identified that nurses have a knowledge deficit regarding pain and its management, as well an erroneous attitudes, which combined are blamed for an inability to make significant progress in this area. This study was undertaken to uncover the contextual aspects of working within a New Zealand health care institution that affect nurses' ability to manage their patient' pain effectively. It highlights the difficulties and the complicated nature of working within an institution in the 1990's health care environment, where accountability for pain is absent and where pain is often under-assessed and under-treated. By using focus group of nurses, the author notes she was able to uncover constructions on nursing practice, which, she suggests, have been missing from the literature, but prevent nurses from implementing their knowledge. Using a constructivist research, she used nurse's stories and current literature to argue one way forward in, what she terms, the pain management debacle. This study revealed a diverse range of contextual factors that prevent nurses from using their knowledge. Many of the constraints on nursing practice are the results of complex organisational structures within health reform, which have significantly affected the nurse's ability to provide quality-nursing care. One of the most important factors limiting the management of the patient' pain is the inability of the nurse to autonomously initiate analgesia. While nurses are largely responsible for the assessment of pain, they are usually powerless to access necessary analgesia, without a medical prescription. The author argues that once an initial medical diagnosis has been made, nurses are usually left responsible for patient comfort and the management of pain. To do so effectively, nurses need to able to prescribe both pharmacological and non-pharmacological measures for the patient. Presently nurses are prescribing using a variety of illegitimate mechanisms, needing the endorsement of a doctor. To fulfil this role, nurses must be adequately prepared educationally and given the authority to either prescribe autonomously, of provided with extensive “standing orders”. While legislative changes in New Zealand in 1999 extended prescribing right to a few nurses within certain areas of care, the ward nurse is unlikely to gain prescribing rights in the near future. The author concludes that a way forward may be to encourage and further develop the use of protocols for managing pain via standing orders. Standing orders are common place within nursing practice today, have the support of the Nursing Council of New Zealand and are currently under-going legislative review. An institutional commitment to developing pain protocols for nurses would recognise the nurses active role and expertise in the management of pain and facilitate expedient relief for the patient. |
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Call Number |
NRSNZNO @ research @ |
Serial |
909 |
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