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Evans, S. (2007). Silence kills: Challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16–19.
Abstract: The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals.
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Warren, B. L. (2007). Using paracetamol before immunisation: Does it work? Kai Tiaki: Nursing New Zealand, 13(5), 24–26.
Abstract: The author presents a review of evidence on the prophylactic use of paracetamol prior to infant and child immunisation. The research was prompted when the Otago District Health Board was planning its Meningococcal B strategy. The evidence suggests that it was appropriate when the whole cell pertussis vaccine was used, but it was not recommended since the introduction of better vaccines such as acellular pertussis with fewer antigens and fewer side effects. Paracetamol may still be given orally to treat pain and fever that occasionally follows vaccination. Paracetamol pharmacology is presented, along with alternatives to paracetamol.
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Barber, M. (2007). Exploring the complex nature of rural nursing. Kai Tiaki: Nursing New Zealand, 13(10), 22–23.
Abstract: This article reports the results of a research study undertaken to examine how nurses manage their professional and personal selves while working in small rural communities. The participants were a small group of rural nurses on the West Coast. The rationale for the study was the long-term sustainability and viability of the service to this remote area. The research showed that the rural nurse specialists' role is a complex and challenging one, performed within the communities in which nurses live.
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Macfie, B. (2006). Assessing health needs and identifying risk factors. Kai Tiaki: Nursing New Zealand, 12(6), 16–18.
Abstract: In 2004, Plunket nurses from eight areas around New Zealand participated in collecting data for a research project on health needs assessment practices. This project aimed to examine risk factors identified by Plunket nurses, what areas of health need considered to be priorities; grading of health needs; and how closely the results of health need assessment aligned with the individual clients' deprivation score. The researchers examine the assessment of health needs against the use of the Deprivation Index, which indicates a specific population in a specific area, as a funding model. This study appeared to show there are two distinct groups of clients assessed as high needs: those with risk factors such as family violence and severe parental mental illness, and who may live in an area of 1-7 deprivation; and those with multiple risk factors which include poverty, low education, and/or reluctance to access services and support, and who usually live in dep 8-10 areas. This research supports the anecdotal evidence that significant health needs exist outside the lower deprivation areas.
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Manning, J. (2006). Building trust with families in neonatal intensive care units. Kai Tiaki: Nursing New Zealand, 12(6), 18–20.
Abstract: Establishing a trusting relationship is a key therapeutic intervention for nurses working with families of hospitalised children. This article is an exploration of the definition of trust. Specifically, it considers how parents come to trust (or not) nurses in neonatal intensive care unit (NICU) helps to reveal the meaning of parent-nurse trust and how this affects nursing practice. Understanding and meeting parental needs is important in developing and sustaining trust. The medical model of care often dominates in NICU. This is a deficit model that focuses on illness and treatment. However, the use of a nursing framework, such as developmentally supportive family centred care, focuses on recognising and building on the strengths of the family, by fostering trust to equip the family with the capacity to manage their infant's health care.
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Challis-Morrison, S. (2006). Caring for a community wanderer. Kai Tiaki: Nursing New Zealand, 12(11), 20–22.
Abstract: A community based registered nurse from Waikato District Health Board's Older Persons Assessment Team (OPAT) presents her experiences of working with older people with dementia. She uses a case study approach to highlight the issue of wandering, behaviour which can be difficult to modify and can cause carer distress. She outlines a team approach to the condition which requires good communication and co-ordination. Key aspects of management included a risk assessment plan, support for caregivers, and encouraging activity.
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Hunt, M. (2006). Nurses can enhance the pre-operative assessment process. Kai Tiaki: Nursing New Zealand, 12(10), 20–22.
Abstract: This reports on an initiative at Whakatane Hospital, where a Nurse-Led pre-assessment (NLPA) was delivered at an outpatients clinic. NLPA involves taking a comprehensive medical history, a nursing assessment, physical examination, airway assessment, ordering appropriate investigations and carefully documenting the process and results. More valuably, it provides an opportunity for the patient to participate in planning their care. The aim of this initative was to short circuit delays and congestion in existing pre-assessment clinics, streamline the pre-assessment process and reduce the number of patient visits to hospital. Reducing cancellations of surgery (often on the day of surgery) and “did not appear” (DNA) numbers were also objectives. After a small pilot, a six-month trial was funded by the Ministry of Health. Over the six-month trial, 373 patients attended NLPA; 178 patients required anaesthetist review before surgery, and 198 could proceed directly to surgery following NLPA. An anonymous postal survey was made of patients, who indicated satisfaction with the service. Other outcomes are discussed, and the trial was deemed successful. Follow up plans have been disrupted by restructuring at the hospital and the clinic has yet to be implemented.
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McKenna, B., O'Brien, A. J., Dal Din, A., & Them, K. (2006). Responsible clinician role offers opportunities for nurses. Kai Tiaki: Nursing New Zealand, 12(11), 12–14.
Abstract: The authors report on a recent study investigating the statutory role of responsible clinician. Statutory roles under mental health legislation offer mental health nurses a means of having advanced practice skills recognised, as well as contributing to improved access to services. There is a proliferation of roles intended to develop nursing readership, but in most cases they are not primarily clinical roles. The concept of “advanced practice” has become a means of developing clinical leadership roles in nursing. Research on responsible clinician role is presented along with the results of a survey of the 11 Registered Nurses practicing as responsible clinicians, five senior nurses from each of the 21 district health boards, and the Auckland Regional Forensic Psychiatry Services (n = 121). Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain or maintain that role. They were also asked which competencies for the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. A clear majority of the respondents felt the role of the responsible clinician was a legitimate advanced practice role for mental health nurses. Despite this, some respondents expressed ambivalence about taking on the role. The research highlighted deficits in knowledge and skills that could become a focus of education for advanced practitioners seeking appointment as responsible clinicians. Deficits included some assessment skills, knowledge of a range of interventions and knowledge of other legislation affecting mental health legislation.
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Polley, H. (2006). Treating wounds with oxygen. Kai Tiaki: Nursing New Zealand, 12(2), 16–17.
Abstract: This article overviews the use of hyperbaric oxygen treatment in New Zealand primarily for chronic wounds, those who have had radiation therapy and those who are having or who have had head and neck surgery. In New Zealand there are just three hyperbaric oxygen treatment units: The Devonport Naval Base and The Oxygen Therapy Clinic, both in Auckland; and the Hyperbaric Medicine Unit in Christchurch; thus access to this treatment is limited.
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Murphy, R. (2005). A day in the life of an acute hospital psychiatric nurse. Kai Tiaki: Nursing New Zealand, 11(9), 24–25.
Abstract: A nurse presents a personal account of a typical day at Middlemore Hospital's 50-bed acute inpatient mental health unit Tiaho Mai. The article covers aspects of shift handover, working with multidisciplinary teams, developing care plans, working with families, and responding to emergencies.
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Richardson, S. (2005). Coping with outbreaks of the norovirus. Kai Tiaki: Nursing New Zealand, 11(7).
Abstract: The author presents an overview of the impact and management of novovirus infections in New Zealand. The impact of this highly contagious virus on hospital settings is serious. With staff shortages already a problem, any outbreak of contagious disease has the potential to result in unsafe staffing, either through low numbers or poor skill mix. A report from New Zealand Environmental Science and Research (ESR) showed 35 reported norovirus outbreaks in New Zealand in the first quarter of 2004, resulting in 890 cases of the disease. Norovirus outbreaks are characterised by a rapid spread of infection, high uptake rate, and a high proportion of cases presenting with projectile vomiting. The author provides a definition of the novovirus, and looks at transmission, the management of hospital outbreaks, and the impact on emergency departments and hospital wards. Procedures include in-patient isolation. She notes there are no simple answers or “quick fixes” to the problem of norovirus outbreaks. While ongoing surveillance, recognition and isolation are key elements, there are wider structural and political implications that need to be acknowledged. These issues include overcrowding and staff shortages.
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Brinkman, A., & Caughley, B. (2004). Measuring on-the-job stress accurately. Kai Tiaki: Nursing New Zealand, 18(8), 12–15.
Abstract: The authors discuss the usefulness of a generic tool to measure job stress in New Zealand workplaces, and report on a study using one such generic tool. The study involved sending questionnaires to all staff (193) who had worked at a regional women's health service for a minimum of six months. The mailed package contained the Job Stress Survey (JSS), the General Health Questionnaire (GHQ-12), demographic questions (including cultural safety), shift work questions, and a blank page for “qualitative comment”. Over 12,000 pieces of data were collected from the study but this article focuses only on the results of the JSS. The JSS can be used to determine a “job stress index” and can also be used to measure “job pressure” and “lack of organisational support”. For this study, job stress index scores were calculated and organised by occupational groupings. Midwives, nurses and doctors all cited inadequate or poor quality equipment, excessive paperwork, insufficient personal time, and frequent interruptions, as their top stressors. Three of these four stressors fall within the job pressure index. The results of the survey prompted organisational changes, including: extensive discussions; equipment being updated; management being made aware of the depth of concern felt by staff; the creation of a place for staff to have personal time; and coping intervention strategies were initiated. The authors suggest that no generic measure of job stress can fully evaluate stressors unique to a particular work setting. They support additional items being constructed and administered to assess stressors that are idiosyncratic to a particular occupational group.
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Evans-Murray, A. (2004). Meeting the needs of grieving relatives. Kai Tiaki: Nursing New Zealand, 10(9), 18–20.
Abstract: This article examines the role of nurses working in intensive care units who may need to work with families as they face the death of a loved one. How the nurse communicates with relatives during these crucial hours prior to the death can have profound implications on their grief recovery. Universal needs for families in this situation have been identified in the literature, and include: hope; knowing that staff care about their loved one; and having honest information about their loved one's condition. A case study is used to illustrate key skills and techniques nurses can employ to help meet these universal needs. In the first stage of grief the bereaved is in shock and may feel a sense of numbness and denial. The bereaved may feel confused and will have difficulty concentrating and remembering instructions, and they may express strong emotions. Studies on families' needs show that honest answers to questions and information about their loved one are extremely important. It is often very difficult for the nurse to give honest information when the prognosis is poor. Good communication skills and techniques are discussed, in which hope is not offered at the expense of truthfulness, and the nurse facilitates the process of saying goodbye and expressing emotions. Practical techniques, such as including the family in basic care such as foot massaging and simple hygiene routines, may also be used to move the family from being bystanders to the impending death, to comforters.
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Harding, T. S. (2004). Male nurses: The struggle for acceptance. Kai Tiaki: Nursing New Zealand, 9(4), 17–19.
Abstract: This article describes the role of men in the nursing profession in New Zealand from colonial times to the 1970s. It considers attitudes towards male nurses, the provision of training for men and the various laws and regulations dealing with the issue.
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Burrell, B. (2003). Mixed-sex rooms: Invading patients' privacy? Kai Tiaki: Nursing New Zealand, 9(4), 26–28.
Abstract: The author considers the issue of mixed-sex rooming (MSR) in New Zealand hospitals. A review of the literature is presented, with a focus on the attitudes and experiences of patients in the UK, where the issue has been most practised and studied. Findings of a survey of a group of New Zealand female patients are presented. The patients feelings of embarrassment and loss of dignity and privacy are discussed. The legal issues are explored, with the practice evaluated against the patient's rights detailed in the Code of Health and Disability Services and the Privacy Act 1993.
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