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Author |
McCloskey, B.A.; Diers, D. |
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Title |
Effects of New Zealand's health reengineering on nursing and patient outcomes |
Type |
Journal Article |
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Year |
2005 |
Publication |
Medical Care |
Abbreviated Journal |
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Volume |
43 |
Issue |
11 |
Pages  |
1140-1146 |
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Keywords |
Patient safety; Organisational change; Nursing; Hospitals |
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Abstract |
This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1052 |
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Author |
Huntington, A.D.; Gilmour, J.A. |
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Title |
A life shaped by pain: Women and endometriosis |
Type |
Journal Article |
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Year |
2005 |
Publication |
Journal of Clinical Nursing |
Abbreviated Journal |
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Volume |
14 |
Issue |
9 |
Pages |
1124-1132 |
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Keywords |
Female; Diseases; Nurse practitioners; Pain management; Endometriosis; Feminist critique |
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Abstract |
The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. A qualitative research design informed by feminist research principles was chosen for this project. Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. The diagnostic process typically took 5-10 years indicating that primary health care practitioners need higher levels of 'suspicion' for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. The authors conclude this is an area for the development of the nurse practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition. |
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Call Number |
NRSNZNO @ research @ |
Serial |
940 |
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Author |
Cook, N.; Phillips, B.N.; Sadler, D. |
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Title |
The Tidal Model as experienced by patients and nurses in a regional forensic unit |
Type |
Journal Article |
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Year |
2005 |
Publication |
Journal of Psychiatric & Mental Health Nursing |
Abbreviated Journal |
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Volume |
15 |
Issue |
5 |
Pages |
536-540 |
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Keywords |
Psychiatric Nursing; Nursing models; Evaluation; Nurse-patient relations |
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Abstract |
This study looks at the effect of implementing the Tidal Model at Rangipapa, a regional secure mental health forensic unit. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four registered nurses and four “special patients”. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery. |
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Call Number |
NRSNZNO @ research @ |
Serial |
941 |
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Author |
Hylton, J.A. |
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Title |
Relearning how to learn: Enrolled nurse transition to degree at a New Zealand rural satellite campus |
Type |
Journal Article |
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Year |
2005 |
Publication |
Nurse Education Today |
Abbreviated Journal |
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Volume |
25 |
Issue |
7 |
Pages |
519-526 |
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Keywords |
Registered nurses; Enrolled nurses; Education; Maori; Scope of practice; Careers in nursing; Rural nursing |
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Abstract |
This paper reports a study that examined the factors that assisted or hindered the transition of a group of enrolled nurses to registration/degree programmes, via a flexible course developed by a North Island tertiary institution. The study follows ten enrolled nurses, primarily Maori and working in rural settings, as they continued to work while studying at a small satellite campus. The study was exploratory and descriptive, and utilised focus group interviews. Two major categories emerged from comparative analysis of the data. One category entitled 'relearning how to learn', demonstrated the cognitive and behavioural adaptations made and is the focus of this paper. The other category 'barriers and catapults', demonstrated the physical and environmental factors that influenced the students' transition but is outside the scope of this paper. Recent changes in New Zealand nursing education have witnessed the clarification of scopes of nursing practice and the controversial development of a new Certificate in Health Science (Nurse Assistant). Currently enrolled nurses are again facing threats to employment and it is envisaged that many will be seeking to undertake transition to registered nurse in the near future. |
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Call Number |
NRSNZNO @ research @ |
Serial |
842 |
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Author |
Spence, D. |
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Title |
Hermeneutic notions augment cultural safety education |
Type |
Journal Article |
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Year |
2005 |
Publication |
Journal of Nursing Education |
Abbreviated Journal |
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Volume |
44 |
Issue |
9 |
Pages |
409-414 |
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Keywords |
Cultural safety; Nursing; Education; Transcultural nursing |
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Abstract |
In this article, the author integrates literature pertaining to the implementation of kawa whakaruruhau, or cultural safety, with the findings of a hermeneutic project that described the experience of nursing people from cultures other than one's own. It is argued that the Gadamerian notions of “horizon,” “prejudice,” and “play” can be used to facilitate understanding of the tensions and contradictions inherent in cross-cultural practice. Strategies are recommended that enable students to explore the prejudices, paradoxes, and possibilities experienced personally and professionally. |
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Call Number |
NRSNZNO @ research @ |
Serial |
704 |
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Author |
Wareham, P.; McCallin, A.; Diesfeld, K. |
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Title |
Advance directives: The New Zealand context |
Type |
Journal Article |
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Year |
2005 |
Publication |
Nursing Ethics |
Abbreviated Journal |
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Volume |
12 |
Issue |
4 |
Pages |
349-359 |
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Keywords |
Law and legislation; Patient rights; Nursing; Ethics |
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Abstract |
Advance directives convey consumers' wishes about accepting or refusing future treatment if they become incompetent. There are associated ethical issues for health practitioners and this article considers the features that are relevant to nurses. In New Zealand, consumers have a legal right to use an advance directive that is not limited to life-prolonging care and includes general health procedures. Concerns may arise regarding a consumer's competence and the document's validity. Nurses need to understand their legal and professional obligations to comply with an advance directive. What role does a nurse play and what questions arise for a nurse when advance directives are discussed with consumers? This article considers the cultural dimensions, legal boundaries, consumers' and providers' perspectives, and the medical and nursing positions in New Zealand. |
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Call Number |
NRSNZNO @ research @ 1069 |
Serial |
1054 |
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Author |
Giddings, D.L.S. |
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Title |
Health disparities, social injustice, and the culture of nursing |
Type |
Journal Article |
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Year |
2005 |
Publication |
Nursing Research |
Abbreviated Journal |
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Volume |
54 |
Issue |
5 |
Pages |
304-312 |
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Keywords |
Cross-cultural comparison; Racism; Attitude of health personnel; Feminist critique |
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Abstract |
The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analysed using a life history immersion method. Nursing remains attached to the ideological construction of the “White good nurse.” Taken-for-granted ideals privilege those who fit in and marginalise those who do not. The nurses who experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the “White good nurse” must be challenged. Nurses need skills to deconstruct the marginalising social processes that sustain inequalities in nursing and healthcare. These hidden realities-racism, sexism, heterosexism, and other forms of discrimination-will then be made visible and open to challenge. |
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Call Number |
NRSNZNO @ research @ |
Serial |
943 |
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Author |
Alavi, C. |
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Title |
Breaking-in bodies: Teaching, nursing, initiations or what's love got to do with it? |
Type |
Journal Article |
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Year |
2005 |
Publication |
Contemporary Nurse |
Abbreviated Journal |
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Volume |
18 |
Issue |
3 |
Pages |
292-299 |
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Keywords |
Nursing; Education; Psychology; Nurse-patient relations; Students |
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Abstract |
This paper discusses how students become able to work with sick patients for whom they may feel disgust or discomfort. It is a sustained engagement with the literature on abjection and disgust and is not the outcome of evaluation research. It considers the role of problem-based learning pedagogy in facilitating students' negotiation of their own discomfort and horror, and describes experiences which enable them to approach abject patients with more comfort and less disgust. The paper argues the importance of creating spaces where students can explore issues which are distressing and disturbing so that they will feel able to remain in nursing. |
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Call Number |
NRSNZNO @ research @ |
Serial |
658 |
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Author |
Giddings, D.L.S. |
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Title |
A theoretical model of social consciousness |
Type |
Journal Article |
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Year |
2005 |
Publication |
Advances in Nursing Science |
Abbreviated Journal |
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Volume |
28 |
Issue |
3 |
Pages |
224-239 |
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Keywords |
Attitude of health personnel; Feminist critique; Nursing models |
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Abstract |
The article presents a theoretical model of social consciousness developed from nurses' life histories. A 3-position dialectical framework (acquired, awakened, and expanded social consciousness) makes visible the way people respond to social injustice in their lives and in the lives of others. The positions coexist, are not hierarchical, and are contextually situated. A person's location influences her or his availability for social action. Nurses who could most contribute to challenging social injustices that underpin health disparities are relegated to the margins of mainstream nursing by internal processes of discrimination. The author suggests that more inclusive definitions of “a nurse” would open up possibilities for social change. |
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Call Number |
NRSNZNO @ research @ |
Serial |
944 |
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Author |
Friedel, J.; Treagust, D.F. |
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Title |
Learning bioscience in nursing education: Perceptions of the intended and the prescribed curriculum |
Type |
Journal Article |
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Year |
2005 |
Publication |
Learning in Health & Social Care |
Abbreviated Journal |
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Volume |
4 |
Issue |
4 |
Pages |
203-216 |
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Keywords |
Nursing; Education; Teaching methods |
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Abstract |
This study used a curriculum inquiry framework to investigate the perceptions of 184 nursing students and nurse educators in relation to bioscience in the nursing curriculum. Nursing students were found to have significantly more positive attitudes to bioscience in nursing education than nurse educators, and nurse educators were not found to have significantly better self-efficacy in bioscience than the students, although this might have been expected. The results of focus group discussions, used to investigate this in more depth, suggested that some nurse educators and clinical preceptors may not have sufficient science background or bioscience knowledge, to help nursing students apply bioscience knowledge to practice. As a result of this, it is suggested that the aims of the intended and prescribed nursing curricula are not being fulfilled in the implemented curriculum. |
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Call Number |
NRSNZNO @ research @ |
Serial |
713 |
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Author |
Richardson, F.I.; Carryer, J.B. |
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Title |
Teaching cultural safety in a New Zealand nursing education program |
Type |
Journal Article |
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Year |
2005 |
Publication |
Journal of Nursing Education |
Abbreviated Journal |
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Volume |
44 |
Issue |
5 |
Pages |
201-208 |
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Keywords |
Cultural safety; Nursing; Education; Teaching methods; Feminist critique; Treaty of Waitangi; Maori |
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Abstract |
This article describes the findings of a research study on the experience of teaching cultural safety. As a teacher of cultural safety, the first author was interested in exploring the experience of teaching the topic with other cultural safety teachers. A qualitative approach situated in a critical theory paradigm was used for the study. The study was informed by the ideas of Foucault and feminist theory. Fourteen women between ages 20 and 60 were interviewed about their experience of teaching cultural safety. Five women were Maori and 9 were Pakeha. Following data analysis, three major themes were identified: that the Treaty of Waitangi provides for an examination of power in cultural safety education; that the broad concept of difference influences the experience of teaching cultural safety; and that the experience of teaching cultural safety has personal, professional, and political dimensions. These dimensions were experienced differently by Maori and Pakeha teachers. |
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Call Number |
NRSNZNO @ research @ |
Serial |
885 |
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Author |
Lake, Sarah Elizabeth |
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Title |
Nursing Prioritisation of the Patient Need for Care:Tacit Knowledge of Clinical Decision Making in Nursing |
Type |
Book Whole |
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Year |
2005 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
193 p. |
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Keywords |
Clinical decision-making; Patients; Prioritisation; Need for care |
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Abstract |
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. 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. Examines the body of knowledge pertaining to clinical decision-making in nursing, suggesting that 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. |
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Call Number |
NZNO @ research @ |
Serial |
1531 |
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Author |
Farrow, T.; O'Brien, A.J. |
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Title |
Discourse analysis of newspaper coverage of the 2001/2002 Canterbury, New Zealand mental health nurses' strike |
Type |
Journal Article |
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Year |
2005 |
Publication |
International Journal of Mental Health Nursing |
Abbreviated Journal |
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Volume |
14 |
Issue |
3 |
Pages |
187-195 |
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Keywords |
Mental health; Nursing specialties; Industrial relations |
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Abstract |
This paper reports on research into print media representations of industrial disputes in Canterbury in 2001, when mental health nurses undertook a variety of strike actions after stalled negotiations with the local district health board. One response to these actions was the temporary reduction of many of the regions' mental health services. The researchers identified themes of juxtaposed but largely deprecatory images of both mental health nursing and of consumers of services. Some professional nursing voices were given print space during the strike; however, these were largely incorporated into existing discourses rather than offering a nursing viewpoint on the strike. The researchers suggest organisational efforts to focus on ways of ensuring that mental health nurses are seen as a legitimate authority by the media. |
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Call Number |
NRSNZNO @ research @ |
Serial |
692 |
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Author |
Gasquoine, S.E. |
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Title |
Mothering a hospitalized child: It's the 'little things' that matter |
Type |
Journal Article |
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Year |
2005 |
Publication |
Journal of Child Health Care |
Abbreviated Journal |
coda, An Institutional Repository for the New Zealand ITP Sector |
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Volume |
9 |
Issue |
3 |
Pages |
186-195 |
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Keywords |
Nurse-family relations; Parents and caregivers; Paediatric nursing; Children |
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Abstract |
This article reports one aspect of a phenomenological study that described the lived experience of mothering a child hospitalised with acute illness or injury. The significance for mothers that nurses do the 'little things' emerged in considering the implications of this study's findings for nurses in practice. Seven mothers whose child had been hospitalised in the 12 months prior to the first interview agreed to share their stories. The resulting data were analysed and interpreted using van Manen's interpretation of phenomenology. This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalisation of their children. It supports the philosophy of family-centred care and highlights the ability of individual nurses to make a positive difference to a very stressful experience by acknowledging and doing 'little things', because it is the little things that matter to the mothers of children in hospital. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1053 |
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Author |
Fourie, W.; McDonald, S.; Connor, J.; Bartlett, S. |
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Title |
The role of the registered nurse in an acute mental health inpatient setting in New Zealand: Perceptions versus reality |
Type |
Journal Article |
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Year |
2005 |
Publication |
International Journal of Mental Health Nursing |
Abbreviated Journal |
Available online from Coda: An institutional repository for the ITP sector |
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Volume |
14 |
Issue |
2 |
Pages |
134-141 |
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Keywords |
Psychiatric Nursing; Nurse-patient relations; Organisational change |
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Abstract |
This study compared the perceptions that registered psychiatric nurses have of their roles with their actual practice. Following the closure of large scale psychiatric institutions in New Zealand, there was was an increased demand for limited beds in acute inpatient facilities for acutely mentally ill patients. This change in location and downsizing of acute inpatient beds challenged traditional roles of mental health nursing, resulting in confusion over what roles mental health nurses should now perform in the new context of care. This qualitative descriptive exploratory study observed nursing practice on three selected wards and used focus group interviews to establish from registered nurses what they perceived their roles to be. A key finding of this study was that many of the nursing roles related to delivering care from a crisis management perspective, which covers aspects such as assessment, stabilisation of symptoms and discharge planning. Participants also believed that the therapeutic relationship was a fundamental role in inpatient care. Nurses used any opportunity to make it a reality such as kitchen organisation, medications, or dealing with a challenging patient. This study highlighted the complexity of the roles that nurses performed and went some way to give voice to what at times seems an invisible practice. |
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Call Number |
NRSNZNO @ research @ |
Serial |
875 |
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