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Maloney-Moni, J. (2004). Kia Mana: A synergy of wellbeing. Ph.D. thesis, , .
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Shelah, G. E. (2003). Enabling pedagogy: An enquiry into New Zealand students' experience of bioscience in pre-registration nursing education. Ph.D. thesis, , .
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Van der Harst, J. (2003). Inside knowledge: A qualitative descriptive study of prison nursing in New Zealand. Ph.D. thesis, , .
Abstract: Analysis of the research literature on prison nursing revealed a paucity of research, both in New Zealand and internationally. The aim of this research was to describe the working life of the nurse in a New Zealand prison and provide an understanding of and documentation on prison nursing in New Zealand. A qualitative descriptive study was undertaken to determine what it is like to nurse in a New Zealand prison. Ten nurses working at two public prisons and one private prison took part in the study. Data was collected by the use of semi-structured interviews and analysed thematically into four main themes. The participants' descriptions of their working lives as prison nurses expose the multifaceted nature of this work and the inherent relational dynamics. These dynamics determine the nurse's ability to practise effectively in the prison setting. Findings highlighted many paradoxical situations for nurses when working in this environment. The very aspects of the work that participants described as negative were also identified, in some instances, as challenging and satisfying.
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Seton, K. M. (2004). Diversity in action: Overseas nurses' perspectives on transition to nursing practice in New Zealand. Ph.D. thesis, , .
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Doughty, L. (2004). Evaluation of the 2002 Auckland District Health Board: First year of clinical practice programme. Ph.D. thesis, , .
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Williams, J. L. (2003). The Cummins model: An adaption to assist foreign nursing students in New Zealand. Ph.D. thesis, , .
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Whitehead, N. (2007). Quality and staffing: Is there a relationship in aged residential care. Master's thesis, , .
Abstract: This thesis reports a mixed methods study, longitudinal in nature, of consenting Age Related Residential Care (ARRC) hospitals in the upper half of the North Island, which was conducted to examine several factors, including AARC hospital efficiency at producing adverse event free days for residents. An interpretativist approach examined what best practice strategies were implemented by the ARRC hospitals that were identified to be most successful at producing adverse event free days for the residents.
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Palmer, S. G. (1993). Positively positive: an experimental evaluation of the Wellness Programme, Burnett Centre. Ph.D. thesis, , .
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Howard, F. M. (1983). Staff – patient interaction patterns in hospital and community psychiatric facilities, a comparison. Ph.D. thesis, , .
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McDonald, S. (2004). Registered nurses' perceptions of their role in acute inpatient care in New Zealand: A qualitative descriptive study. Ph.D. thesis, , .
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Key, R., Cuthbertson, S., & Streat, S. J. (1995). Critical care survivors follow-up service. Ph.D. thesis, , .
Abstract: The extent of early remediable morbidity after critical illness is unclear. We began a follow-up service to determine outcomes, facilitate rehabilitation and remedy service deficiencies. A critical care nurse identified hospital survivors (DCCM and hospital databases), completed a structured telephone interview with the patient and intervened according to predetermined guidelines. Of 261 admission 1/1/95 29/3/95 50 died in hospital (39in DCCM). Of 211 hospital survivors (M115, age 15-84 median40) 31 could not be contacted, one died at home and 179 contacts were made 21- 120 (median 51) days after DCCM. One refused interview, 178 interviews took 8-60, (median 15) minutes. Only 68/178 had resumed normal activities and 26/78 workers had returned to work. Seventy patients had contacted general practitioners because of critical illness sequelae. One hundred patients gad 191 problems (including unhealed wounds29, pain 28, impaired mobility26, neurological deficit 178, infection 10 weight loss 9, tiredness 6 depression 5, sleep disturbance 3, others 57). Sixty-five described DCCM staff as helpful, 37 had complaints (hallucinations 6, staff behaviour5, restraints5 sedation/analgesia inadequate5 or excessive 2, poor communication3, fear3, noise 2 other 4) and 5 raised serious non-DCCM issues. Forty-four patients were called again 6-84, median 42 days later when 69/112 health problems had resolved but 29/44 patients had not resumed normal activity. Four attended a clinic and were referred to other services. A follow-up service is well received. Morbidity is common but improves within three months after critical care. We are addressing service issues
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Stokes, G. (2005). Who cares? Accountability for public safety in nurse education. Ph.D. thesis, , .
Abstract: The focus of this study is the management of unsafe nursing students within the tertiary education context. The moral dilemmas experienced by nurse educators, specifically linked to the issue of accountability for public safety, are explored. The theoretical framework for the thesis is informed by the two moral voices of justice and care identified by Gilligan and further developed using the work of Hekman and Lyotard. Case study methodology was used and data were collected from three schools of nursing and their respective educational organisations. Interviews were conducted with nurse educators and education administrators who had managed unsafe nursing students. Interviews were also conducted with representatives from the Nursing Council of New Zealand and the New Zealand Nurses Organisation to gain professional perspectives regarding public safety, nurse education and unsafe students. Transcripts were analysed using the strategies of categorical aggregation and direct interpretation. Issues identified in each of the three case studies were examined using philosophical and theoretical analyses. This thesis explores how students come to be identified as unsafe and the challenges this posed within three educational contexts. The justice and care moral voices of nurse educators and administrators and the ways in which these produced different ways of caring are made visible. Different competing and conflicting discourses of nursing and education are revealed, including the discourse of safety – one of the language games of nursing. The way in which participants positioned themselves and positioned others within these discourses are identified. Overall, education administrators considered accountability for public safety to be a specific professional, nursing responsibility and not a concern of education per se. This thesis provides an account of how nurse educators attempted to make the educational world safe for patients, students, and themselves. Participants experienced different tensions and moral dilemmas in the management of unsafe students, depending upon the moral language games they employed and the dominant discourse of the educational organisation. Nurse educators were expected to use the discourses of education to make their case and manage unsafe students. However, the discourses of nursing and education were found to be incommensurable and so the moral dilemmas experienced by nurse educators were detected as differends. This study bears witness to these differends.
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Key, R., Habashi, S., Baber, C., Cuthbertson, S., & Streat, S. J. (1994). Long-term follow-up after Bjork flap tracheostomy. Ph.D. thesis, , .
Abstract: Because of concern about long-term complications of bjork flap tracheostomy we followed-up 136 intensive care patients who had Bjork flap tracheotomy in 1992 a median of 117 (range 5-402) hours after intubation. Twenty died in hospital, none as a result of tracheostomy. Twenty- six patients were lost to follow-up and eleven declined. The remaining 79 had measures of health status, a quality of life questionnaire, respiratory function testing and physical examination of the neck and upper airway 9-27 months (median 14) later. Various health status measures deteriorated in 9 to 51 of 77 patients. Forty-two of 77 patients were taking prescription medication and 15/32 smokers had stopped smoking. FEV1, FVC and FEV1/FVC were significantly reduced from predicted normal (n=70, 2.8+ 1.1 vs 3.2 +0.9 p<.0001, 3.7 + 1.3 vs 4.0 + 1.0 p<.0001, 76 +11vs 79 +3 p= 0.035 respectively). Pulse oximetry was normal (>92%) in 73/74 patients tested. The median horizontal scar dimension was 45mm (range 20 to 75 mm). Nine had a median vertical scar dimension 15mm (range 8 to 25mm). Nineteen scars were hypertrophic, 56 were tethered. Two patients had already undergone tracheal scar revision at follow-up and further 13 accepted scar revision. Ten patients had abnormal voice examination, four abnormal cough, two stridor, three vocal cord lesions, three tracheal polyps and fourteen asymptomatic tracheal narrowing from 10-60% (median 25%) of the tracheal luminal diameter. Patients surviving critical illness with bjork flap tracheostomy have reduced quality of life and respiratory function and poor cosmetic result but a low incidence of important airway problems
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McManus, L. M., Cuthbertson, S., & Streat, S. J. (1998). When the lights went out in Auckland. Ph.D. thesis, , .
Abstract: As the clinical consequences of power failure in intensive care are seldom documented we reviewed the effects of a power failure on patient care, outcomes and the adequacy of our disaster plan. We reviewed clinical records of all ten patients in our department during a 20-minute total hospital power failure, determined the impact of the failure on the therapies being given, and the costs of failed equipment. We assessed the departments disaster plan and identified the causes of the power failure.Nine patients were intubated; six ventilated (one receiving nitric oxide) and three receiving continuous positive airway pressure. Two patients were ventilated by Servo 300,? which continued on batteries, the other four patients were ventilated manually. Six patients were receiving nine inotrope infusions through IMED Gemini,? (battery life 30 minutes). One patient was receiving high volume ultrafiltration using a Gambro? haemodialysis system, which failed. Blood flow to prevent clotting was maintained by turning the roller pump manually. All networked monitoring (SpaceLabs?) failed and three haemodynamically unstable patients were monitored by transport monitors (SpaceLabs Scout?). No patient suffered any ill effect. Failed electronic circuits cost $NZ11,724. The disaster plan was implemented and functioned well. The aged cables supplying Auckland Central failed during an El Nino summer. The hospital generators, supplying power to the city grid, failed to switch over to the hospital. During power failure infusion pumps should be only for inotropes. We now have external 12-volt battery backup. With good pre-planning, safe intensive care continued during a short power failure
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Pearce, L., Cuthbertson, S., Streat, S. J., & Hay, D. (1996). Dental hygiene in the critically ill: a randomised controlled trial of three methods. Ph.D. thesis, , .
Abstract: Introduction Critically ill patients cannot clean their own teeth. A variety of methods are used but as the best method is unknown we performed a prospective randomised double-blind controlled trial of three methods.Method Of 359 consecutive admissions to the Department of Critical Care Medicine between 31/01/97 and 25/05/97, 222 were excluded (62 edentulous, 6 unexaminable, 142 transferred alive and 12 dead or dying at 24 hours). The remaining 137 patients had quantitative (picture-linked, ordinal score) assessment of caries, peridontal status and plaque (in 12 segments of teeth) before randomisation (to the use of either toothbrush, jumbo swab or sonic toothbrush) by pre-assigned sealed envelopes. All teeth were cleaned (prescribed four hourly) with 0.2% chlorhexidine solution. Daily plaque scores were obtained (by an assessor (SC) blind to treatment allocation) until withdrawal, death or transfer.Results Toothbrush Jumboswab SonicPatients assigned 50 48 39Withdrawn within 24hrs. 9 3 5Patients remaining 41 45 34Percentage of teeth segments thatare pristine: pre treatment 45 50 51 after 2 days 74 57 90 F(2.63) = 5.00 p = 0.0097 More withdrawals for patient noncompliance after randomisation occurred in the sonic group (5/34 versus 3/86). Conclusion. By the second day the sonic toothbrush was the most effective in plaque removal with the toothbrush the next most effective method
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