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Connor, M. (2003). Advancing nursing practice in New Zealand: A place for caring as a moral imperative. Nursing Praxis in New Zealand, 19(3), 13–21.
Abstract: The author argues that the framework of competencies required for advanced nursing practice should include a moral dimension in order to take account of relational as well as functional competencies. There is no recognition of the relational competencies required to practice caring as a moral imperative. The Nursing Council of New Zealand expects that nurses will practise 'in accord with values and moral principles'. The paper explores the history of two nursing discourses, that which sees nursing as a functional occupation and that which emphasises the relationship between nurse and patient. A practice exemplar is used to demonstrate positive outcomes from advanced relational competencies.
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Fourie, W., & Oliver, J. D. (2002). Defining currency of practice for nurse educators. Nursing Praxis in New Zealand, 18(3), 30–39.
Abstract: Recent Nursing Council of New Zealand guidelines for competence-based practising certificates and the fact that all nurse educators must have a current practising certificate prompted the Nursing Schools within the Tertiary Accord of New Zealand (TANZ) to explore issues surrounding current competency in practice and how this can be maintained by nurse educators. The authors note that discussions related to competence-based practising certificates generally refer to competence only in terms of direct patient care. They set out to clarify the issue with specific reference to nurse educators who, by the nature of their scope of practice, often do not carry a patient caseload. They review the literature relating to currency of practice and draw on the findings of a survey of TANZ Nursing Schools and provide a position on how currency of practice applies to nurses working in an educational setting. They present strategies to maintain clinical, teaching and scholarly currency and make some suggestions for providing evidence that currency of practice is maintained.
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Walker, J., & Bailey, S. (1999). The clinical performance of new degree graduates. Nursing Praxis in New Zealand, 14(2), 31–42.
Abstract: This study aimed to identify how graduates perceived their clinical performance during their first year of practice. A convenience sample of 30 graduates was surveyed after 3 months and 7 months in practice, using an adapted form of a questionnaire devised by Ryan and Hodson (1992). The results showed that over time, graduates generally required less direction in all areas of clinical competence. After 7 months in practice, the majority of the graduates rated their performance in nursing skills, communication skills, and professionalism at the expected level or above. However, some still required direction with using theory and research in practice, with meeting client's psychosocial needs and with teaching clients. In the leadership competency, after 7 months, most graduates saw themselves functioning at the expected level related to client care and needed less direction in unit management skills. However, many of the unit management skills were rated as 'not applicable' indicating that new graduates are not initially placed in a management role. Implications for nursing education and limitations of the research are discussed.
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Horner, C. (2008). Emergency health provision and maintaining competency. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 125-136). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter focuses on issues associated with rural nursing and the provision of emergency care for patient(s) located remotely from secondary hospital services. All emergencies have diverse characteristics, but the rural practitioner also contends with having sole practice, professional and geographical isolation, and the lack of regular experience. The chapter reviews the PRIME (Primary Response in Medical Emergency) recommendations and training, and looks in particular at the issues around the maintenance of competency for the rural nurse providing emergency on call health care that includes managing medical and accident emergencies in the absence of a medical practitioner.
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Robertson, A. M. (2008). Rural women and maternity services. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 179-97). [Dunedin]: Rural Health Opportunities.
Abstract: The author discusses the roles that nurses undertake in response to rural communities' health needs, focusing on the provision of maternity service. The author reviews structural changes such as the 1990 Amendment to the Nurses Act 1977 which, the author suggests, introduced a climate of professional rivalry, changes in funding that cut back general practitioners in the field, and the development of Lead Maternity Carers. Despite controversial developments, New Zealand maternity services have evolved to include a unique and internationally respected model of midwifery care. However, the author highlights several areas that limit the positive contribution of rural nurses and midwives. These include workforce recruitment and retention, equity of access, and issues around maintaining competency and education.
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Carryer, J. B., Gardner, G., Dunn, S., & Gardner, A. (2007). The core role of the nurse practitioner: Practice, professionalism and clinical leadership. Journal of Clinical Nursing, 16(10), 1818–1825.
Abstract: This article draws on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. A study jointly commissioned by both countries' Regulatory Boards developed information of the newly created nurse practitioner role, to develop shared competency and educational standards. This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner programme curricula and interviews with 15 nurse practitioners from the two countries. The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care.
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O'Brien, A. P., O'Brien, A. J., Hardy, D. J., Morrison-Ngatai, E., Gaskin, C. J., Boddy, J. M., et al. (2003). The New Zealand development and trial of mental health nursing clinical indicators: A bicultural study. International Journal of Nursing Studies, 40(8), 853–861.
Abstract: This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5-89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.
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Shaw, S. (2007). Constructing media images of nursing: How does the media represent nurses when reporting on nurse prescribing? Kai Tiaki: Nursing New Zealand, 13(1), 16–18.
Abstract: This research presents a discourse analysis of articles published in the New Zealand Herald between October 1999 and September 2005. The terms “nurse prescribing” and “prescribing fights” identified seven articles published which referred specifically to this issue. They were predominantly editorial comments and statements attributed to senior doctors. Examples of comments from these articles are presented and discussed in this article, and three inter-related themes are identified – competence, responsibility and competition. Discussion on competence centred on education, skill and experience level of nurses, as described by editorial comment and senior doctors. Positive international research and experience of nurse prescribing did not feature. A number of comments in the articles analysed could be seen to represent concerns about competition between medicine and nursing. One interpretation of the comments contained in these articles is to see medical practitioner groups defending their status and desire to define and control nursing practice. The media has the power to select the information conveyed and, in these instances, appears to have demonstrated a bias towards the medical community's perspective.
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Floyd, S., & Meyer, A. (2007). Intramuscular injections: What's best practice? Kai Tiaki: Nursing New Zealand, 13(6), 20–22.
Abstract: The aim of this research project was to explore issues around preferred injection site, intramuscular injections injection technique, particularly Z-tracking, and the wearing of gloves while administering intramuscular injections. The researchers conducted a literature search which revealed little published information on the use of intramuscular injections, despite them being part of everyday nursing practice. The guidelines for evidence-based practice in relation to intramuscular injections are reviewed and discussed. A survey of registered nurses on intramuscular injections sites and technique was conducted. An anonymous questionnaire, accompanied by an explanatory letter, was sent to 173 registered nurses working in general practice, prisons, and to community and inpatient mental health nurses. Response questionnaires were collated and a thematic analysis was undertaken. This research findings show that, despite the known iatrogenic complications which could occur when administering intramuscular injections, some registered nurses' practice does not appear to take this in to consideration. Furthermore, the majority of registered nurses did not use gloves and Z-tracking was not widely used among the sample group. The researchers conclude that although intramuscular injections are a fundamental skill, there appears to be limited research and evidence to support best practice. Education and support to change practice to reflect current research is paramount, if registered nurses are to remain competent.
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Smith, M. C. (2008). Reviewing the role of a mental health nurse practitioner. Kai Tiaki: Nursing New Zealand, 14(3), 20–22.
Abstract: The author describes his experience of five years as a nurse practitioner in mental health at Waikato District Health Board. A recent review of the role gave him the opportunity to reflect on the learning associated with assuming the nurse practitioner role. A key area of learning has been in negotiating the shifting responsibilities and changing relationships associated with his role as an nurse practitioner and also as a Responsible Clinician, a role traditionally held by psychiatrists. The Responsible Clinician role is a statutory one under the Mental Health Act (1992), generally performed by psychiatrists but open to other suitably qualified professionals. He reports the results of a review based on feedback from fellow professionals, clients and their families, along with quantitative data from basic statistics connected to the role, such as a time and motion study. The review asked fellow professionals to rate the performance of the nurse practitioner against the Nursing Council competencies. These results indicate the nurse practitioner role is of some value and that other professionals and clients seem satisfied with the role. There is some evidence it is delivering outcomes acceptable to clients and other professionals. The study has many limitations which are discussed, such as a poor response rate and short time frame. Further research is planned to evaluate this role.
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O'Brien, A. P., Boddy, J. M., Hardy, D. J., & O'Brien, A. J. (2004). Clinical indicators as measures of mental health nursing standards of practice in New Zealand. International Journal of Mental Health Nursing, 13(2), 778–788.
Abstract: This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritised in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 district health board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. The authors discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.
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Hardy, D. J., O'Brien, A. P., Gaskin, C. J., O'Brien, A. J., Morrison-Ngatai, E., Skews, G., et al. (2004). Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand. Journal of Advanced Nursing, 46(1), 95–109.
Abstract: The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarised responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark. The authors conclude that when rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritising experts' judgements.
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Gaskin, C. J., O'Brien, A. P., & Hardy, D. J. (2003). The development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. International Journal of Mental Health Nursing, 12(4), 259–270.
Abstract: This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand district health board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.
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Milligan, K., & Neville, S. J. (2001). Health assessment and its relationship to nursing practice in New Zealand. Contemporary Nurse, 10(1/2), 7–11.
Abstract: This article draws on Australian experience to gain insight to three specific areas of health assessment that are topical in New Zealand, which has recently introduced the concept into nursing training. The issues are annual registration based on evidence of competence to practice, a review of undergraduate curricula, and the development of nurse practitioner/advanced nurse practitioner roles. The meaning of the concept 'health assessment' is also clarified in order to provide consistency as new initiatives in nursing are currently being developed.
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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.
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