Armstrong, S. E. (2006). Exploring the nursing reality of the sole on-call primary health care rural nurse (PHCRN) interface with secondary care doctors. Ph.D. thesis, , .
Abstract: A qualitative framework was used to explore the nature and the quality of interactions between sole on-call primary health care rural nurses and secondary care doctors as a component of rural nursing practice and representative of the primary-secondary care interface. Crucial to patient centred care, the premise was that the quality of this interface would be variable due to multiple influences such as: the historical nurse/doctor relationship that has perpetuated medical dominance and nursing subordination; current policy direction encouraging greater inter-professional collaboration; and changing role boundaries threatening traditional professional positioning. A total of 11 nurses representing 10 separate rural areas participated in semi-structured interviews. Rural nurses typically interact with secondary care doctors for acute clinical presentations with two tiers of interaction identified. The first tier was presented as a default to secondary care doctors for assistance with managing primary care level clinical presentations in the absence of access to a general practitioner or an appropriate Standing Order enabling appropriate management. The second tier presented itself as situations where, in the professional judgement of the nurse, the client status indicated a need for secondary level expertise and/or referral to secondary care. The needs of the rural nurse in these interactions were identified as access to expertise in diagnosis, therapy and management, authorisation to act when intervention would exceed the nurse's scope of practice; the need to refer clients to secondary care; and the need for reassurance, encompassing emotional and professional issues. The quality of the interactions was found to be variable but predominantly positive. Professional outcomes of positive interactions included professional acknowledgement, support and continuing professional development. For the patient, the outcomes included appropriate, timely, safe intervention and patient centred care. The infrequent but less than ideal interactions between the participants and secondary care doctors led to professional outcomes of intraprofessional discord, a sense of invisibility for the nurse, increased professional risk and professional dissatisfaction; and for the client an increased potential for deleterious outcome and suffering. Instead of the proposition of variability arising from interprofessional discord and the current policy direction, the data suggested that variability arose from three interlinking factors; appropriate or inappropriate utilisation of secondary care doctors; familiarity among individuals with professional roles and issues of rurality; and acceptance by the primary care doctor of the sole on-call primary health care rural nurse role and the responsibility to assist with the provision of primary health care. Recommendations for improving interactions at the interface include national, regional and individual professional actions.
|
|
Beckingham, C. R. (1983). One great network: the family as an environmental influence in the prose works of Thomas Hardy. Ph.D. thesis, , .
|
Berry, R. (1999). Psychiatric comorbidity and childhood adversity in women seeking treatment for alcohol and/or drug dependence. Ph.D. thesis, , .
Abstract: Eighty alcohol and/or drug dependent women who were consecutive admissions to an outpatient alcohol and drug service were interviewed with the aim of gathering information regarding childhood adversity, psychiatric comorbidity and alcohol and drug history, including extent of treatment and alcohol and drug related criminality. A secondary aim of the study was to investigate associations between both the multiplicity of alcohol and drug dependence diagnosis and the presence of psychiatric comorbidity in relation to exposure to childhood adversity, including sexual, physical and emotional abuse.The data demonstrate that the study sample was a relatively severe group of alcohol and drug dependent women. A sizeable percentage came from backgrounds characterised by parental separation, conflict and alcohol and drug problems. Many were regularly exposed to physical abuse perpetrated by both parents or main parental figures and over two-thirds were exposed to some form of sexual abuse within their first 15 years. Sixty percent had been dependent on more than one psychoactive substance, with half having undergone previous alcohol and drug treatment. The women also presented with substantial histories of criminal convictions, with a quarter having served a prison sentence. The results indicate the presence of extensive psychiatric comorbidity in the sample. Two-thirds of the women met current DSM-IV criteria forat least one of the following Axis I disorders: major depressive syndrome, social phobia or bulimia nervosa, while nearly half had antisocial personality disorder. More importantly, significant associations were found regarding the presence of psychiatric comorbidity in relation to four measures of severe childhood adversity, i.e. childhood sexual, physical and emotional abuse and parental problems. Multiplicity of alcohol and drug dependence diagnosis was associated with severe emotional abuse, severe parental problems andpsychiatric comorbidity. Emotional abuse during childhood was the most pervasive indicator of comorbidity and multiplicity of alcohol and/or drug dependence. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug service may need to routinely screen and plan treatment for unresolved childhood trauma, psychiatric disorder and other problems related to alcohol and drug use in all clients presenting for alcohol and drug treatment
|
|
Bigwood, S. (2007). Got to be a soldier: Mental health nurses experiences of physically restraining patients. Ph.D. thesis, , .
|
Bray, M. L. (1995). Nurses' knowledge of and attitudes to medicine (Vol. 8). Ph.D. thesis, , .
Abstract: Abstract information about attitudes to, and knowledge of, prescribed medication from a group of 70 students and 24 registered nurses at Otago Polytechnic. Employs a self-administered questionnaire previously used in a community survey in Southampton, UK
|
Caygill, J. (1989). Professional care: structure, strategy and the moral career of the nurse in a psychiatric institution (Vol. 8). Ph.D. thesis, , .
Abstract: This thesis presents the job of psychiatric nursing from the nurse's point of view, as derived from the author's personal experience and from interviews with thirty five other staff within a particular psychiatric institution.The first part of the thesis is reconstructed narrative account of an afternoon and a day shift in an acute admission ward. In the second part, the basic situation on the ward and some of the exigencies of nurse-patient and nurse-staff relations are discussed from structuralist and strategic conduct perspectives.The discussion that follows Anthony Giddens' (1976, 1979, 1984) conceptual framework of power, legitimation and signification, with particular attention to the strategic implications of ward routines, nursing practices, and interpersonal relations, as well as the duality of clinical and moralistic interpretive themes. The third part of the thesis 'the nurse's progress' over time. Characteristic changes in understanding and awareness take place with the movement from the 'backwards' to the 'acute' area and from the student to staff nurse. This is portrayed as a 'moral career' analogous to that suggested by Goffman (1968) for psychiatric patients; marked by 'happenings' that generate revised conceptions of self and others, and including those experiences of duality and contradiction discussed in part Two. While acknowledging the diversity of nurses' attitudes and approaches, with variations according to individual temperament, past experiences and the current setting, the suggestion is made of a common and distinctive 'meta-awareness' that develops with the fob
|
|
Chick, D. N. P. (2003). Rural district nurses as rehabilitationists. Ph.D. thesis, , .
|
|
Codlin, K. C. (2004). Mental health nurses and clinical supervision: A naturalistic comparison study into the effect of group clinical supervision on minor psychological disturbance, job satisfaction and work-related stress. Ph.D. thesis, , .
|
|
Goulding, M. T. (2006). The influence of work-related stress on nurses' smoking: A comparison of perceived stress levels in smokers and non-smokers in a sample of mental health nurses. Ph.D. thesis, , .
|
Grant-Mackie, D. (2000). A literature review of competence in relation to speciality nursing. Ph.D. thesis, , .
Abstract: The original aim of the study was to find out through a questionnaire what child health/paediatric nurses in New Zealand/Aotearoa saw as their needs for post-registration education. Nurses were completing courses in the United Kingdom and returning to New Zealand/Aotearoa and realising that their nursing capabilities had improved. They became senior nurses with education responsibilities and exhibited political leadership among their colleagues in the field of child health/paediatric nursing. They were becoming increasingly concerned at the lack of any clinical courses in the specialty of child health/paediatric nursing to promote an appropriate standard of practice. It was intended that a research project about post-registration child health/paediatric education would assist concerned nurses to develop a programme. The time needed for such a project did not fit with a limited research paper. It was decided to reduce the project to a review of the literature on competence in nursing, with some comment on the specialty of child health/paediatric nursing. In order for nurses to find what they need to learn and know, an understanding of competence in nursing practice is required. Competence is defined as the ability of the nurse to carry out specific work in a designated area at a predetermined standard. Issues around competence, defining a scope of practice, development and assessment of competence, and regulation of nursing, are part of the context in which accountability for the practice of nurses sits.
|
|
Gray, H. J. (2006). Clinician or manager: An exploration of duty management in New Zealand hospitals. Ph.D. thesis, , .
|
|
Henderson, A. P. (1994). Nursing a colonial hangover: towards bicultural planning in New Zealand. Ph.D. thesis, , .
|
|
Howie, E. (1989). A nutritional education needs assessment of child health nurses. Ph.D. thesis, , .
|
Jefferson, F. E. (2007). An exploration of the competencies for advanced nursing practice in the perioperative setting.
Abstract: A clinical research practicum.
|
|
Lilley, S. (2006). Experiences of mentoring in primary health care settings: Registered nurses' and students' perspectives. Ph.D. thesis, , .
|
