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Author |
McManus, L.M.; Cuthbertson, S.; Streat, S.J. |
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Title |
When the lights went out in Auckland |
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Year |
1998 |
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Abbreviated Journal |
DCCM, Private Bag 92024 Auckland |
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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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NRSNZNO @ research @ 206 |
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206 |
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Author |
Perry, J.(see also C.) |
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Title |
Currents – towards professionalism |
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Year |
1990 |
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Abbreviated Journal |
Auckland Institute of Technology Library, NZNO Li |
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Attitudes towards the concept of professionalism have not been explored to any great extent in this country, especially the attitudes of the Clinical Nurse practitioner. The importance of knowing what Nurses attitudes are to this concept is central to the recognition of the current developmental stage and growth of the profession. A twenty statement Like-style attitudinal questionnaire was given to Registered Nurses to measure current attitudes to professionalism. No statistical significance was found between the degree of positively to professionalism and years of service, educational qualifications eg, practise area, or involvement with a professional organisation. There appeared to be a positive relationship between questionnaire score and length of time in the current practise area ( the longer the service the higher the score). Further statistical significance was found in questions highlighting what Nurses think of Nursing as a profession. This study should form the basis of further research and provide some thought for Nurse leaders, educators and policy makers |
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NRSNZNO @ research @ 42 |
Serial |
42 |
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Author |
Key, R.; Habashi, S.; Baber, C.; Cuthbertson, S.; Streat, S.J. |
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Title |
Long-term follow-up after Bjork flap tracheostomy |
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Year |
1994 |
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Abbreviated Journal |
DCCM, Private Bag 92024, Auckland |
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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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Call Number |
NRSNZNO @ research @ 201 |
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201 |
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Author |
Margetts, M.; Cuthbertson, S.; Streat, S.J. |
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Title |
Bereavement follow-up service after fatal critical illness |
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Year |
1995 |
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Abbreviated Journal |
DCCM, Auckland Hospital |
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Fatal illness is often short. Communication between patient and family is impaired and how to best meet family needs is unclear. We began a follow-up service to determine current next-of-kins outcomes and remedy service deficiencies. A critical care nurse identified deaths from our data base and completed a structured telephone interview with the next-of-kin. There were 374 admissions from 1/1/95 – 17/5/95, 55 died. Next- of-kin of 52 patients (M29, age 19-88 median 52) were contactable 16-70 (median 33)days later. All (defacto/wives 18, husbands 9, mothers 9, daughters 8, others 8) consented to interview (5 -80, median 15 minutes). Forty-nine had resumed normal home activities and 23/25 workers had returned to work. Thirty-three still had disturbed sleep, three were taking hypnotics. Twenty-four had had contact with their general practitioner because of the death (six were prescribed sedatives or hypnotics). Nineteen had financial problems. Forty-seven described DCCM care positively, 35 specifically (nursing care and compassion 15, communication 8, flexible visitors policy8) but 13 had particular difficulties (communication 4 , waiting 2, facilities 4) and 4 serious non-DCCM issues. Forty-six considered themselves well informed and understood well the sequence of events. Forty-eight identified family and friends as primary support. Three requested information about another agency (counseling), 9 asked us to contact as further relative. A telephone bereavement service is well received by next-of-kin. Most families members resolve their early grief without external agencies but sleep and money are problems. We have improved our facilities and are addressing communication and cultural issues |
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Call Number |
NRSNZNO @ research @ 199 |
Serial |
199 |
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Author |
Hall, J. |
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Title |
Building trust to work with a grounded theory study of paediatric acute care nurses work |
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2004 |
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Abbreviated Journal |
Auckland University of Technology Library |
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Nurse-family relations; Nurse-patient relations; Children; Paediatric nursing; Intensive care nursing |
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Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury. Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse “works with” the child to maintain and advance medical stability. Nursing interactions are an important part of “working with”, communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate. An effective working-relationship with a nurse and family is founded on trust. Grounded theory methods supported the process of exploring the social processes of “building trust” whilst “working with” families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to “work with” and support the re-establishment of the parenting role. The “stepping in and out” of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to “be with”, using chat to get to know each other, involving and supporting the family to parent a “different” child and reassuring and giving realistic hope to help the child and parents cope with their changed future. A substantive theory of the concept of “building trust to work with” has been developed using grounded theory methods. The theory has been conceptualised using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident. |
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NRSNZNO @ research @ |
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597 |
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Author |
Pearce, L.; Kirkham, S.; Cuthbertson, S. |
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Title |
Quality of follow-up for self-poisoning patients after discharge from intensive care: 1996, one year later |
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1996 |
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Abbreviated Journal |
DCCM, Auckland Hospital, P.O.Box 92024, Auckland |
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In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care. |
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Call Number |
NRSNZNO @ research @ 207 |
Serial |
207 |
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Author |
Simich, M.-L. |
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Title |
Women in employment in New Zealand 1911-1926 |
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Year |
1978 |
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Auckland University Library |
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Includes superficial analysis of role of nurses & switch from private to hospital employment |
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Call Number |
NRSNZNO @ research @ 420 |
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420 |
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Author |
Pearce, L.; Cuthbertson, S.; Streat, S.J.; Hay, D. |
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Title |
Dental hygiene in the critically ill: a randomised controlled trial of three methods |
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Year |
1996 |
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Abbreviated Journal |
DCCM, Auckland Hospital, Private Bag 92024, Auck |
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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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NRSNZNO @ research @ 203 |
Serial |
203 |
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Author |
Fielding, S. |
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Title |
Learning to do, learning to be: The transition to competence in critical care nursing |
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Year |
2006 |
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Abbreviated Journal |
Auckland University of Technology Library |
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Keywords |
Intensive care nursing; Preceptorship; Nursing specialties |
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Abstract |
Making the transition to an area of specialist nursing practice is challenging for both the learner and staff who are responsible for education and skill development. This study uses grounded theory methodology to explore the question: “How do nurses learn critical care nursing?” The eight registered nurses who participated in this study were recruited from a range of intensive care settings. The criteria for inclusion in the study included the participant having attained competency within the critical care setting. Data was collected from individual interviews. This study found that nurses focus on two main areas during their orientation and induction into critical care nursing practice. These are learning to do (skill acquisition) and learning to be (professional socialisation). The process of transition involves two stages: that of learning to do the tasks related to critical care nursing practice, and the ongoing development of competence and confidence in practice ability. The relationship of the learner with the critical care team is a vital part of the transition to competency within the specialist area. This study identifies factors that influence the learner during transition and also provides an understanding of the strategies used by the learners to attain competency. These findings are applicable to educators and leaders responsible for the education and ongoing learning of nurses within critical care practice. The use of strategies such as simulated learning and repetition are significant in skill acquisition. However attention must also be paid to issues that influence the professional socialisation process, such as the quality of preceptor input during orientation and the use of ongoing mentoring of the learner. |
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NRSNZNO @ research @ |
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509 |
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Author |
Butler, A.M. |
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Towards a staffing formula: home visit rating scales for community health nurses |
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Year |
1980 |
Publication |
Journal of Advanced Nursing |
Abbreviated Journal |
Auckland Hospital |
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73 |
Issue |
9 |
Pages |
9-14 |
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Abstract |
Reports the development of a set of Rating scales which can be used to measure the Home visiting part of the workload of Community Health Nurses. The scales provide a useful tool for the equitable distribution of Home visits among existing staff and can assist in the assessment of the total workload of the Community Health Nurses |
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Call Number |
NRSNZNO @ research @ 138 |
Serial |
138 |
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Author |
Margetts, M.; Cuthbertson, S.; Streat, S.J. |
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Title |
Bereavement follow-up – its impact on practice |
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Year |
1996 |
Publication |
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Abbreviated Journal |
DCCM Auckland Hospital |
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Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care |
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Call Number |
NRSNZNO @ research @ 200 |
Serial |
200 |
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Author |
Sheridan, N.F. |
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Title |
Mapping a new future: Primary health care nursing in New Zealand |
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Year |
2005 |
Publication |
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Abbreviated Journal |
University of Auckland Library |
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Keywords |
Primary health care; Chronic diseases; Community health nursing; Nursing models |
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The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses' practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses' practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The 'Public health interventions model' was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses' practice were determined using 'Beattie's model of health promotion' as a framework for analysis. A strong association was found between nurses' practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collective-oriented philosophy – coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses' practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The 'Primary Health Care interventions model' was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals. |
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Call Number |
NRSNZNO @ research @ 679 |
Serial |
665 |
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Author |
Key, R.; Cuthbertson, S.; Streat, S.J. |
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Title |
Critical care survivors follow-up service |
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Year |
1995 |
Publication |
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Abbreviated Journal |
Private Bag, 92024, Auckland |
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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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Call Number |
NRSNZNO @ research @ 202 |
Serial |
202 |
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Author |
Stokes, G. |
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Title |
Who cares? Accountability for public safety in nurse education |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Online at Research Space @ Auckland University |
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Keywords |
Nursing; Education; Accountability; Patient safety |
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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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NRSNZNO @ research @ |
Serial |
1106 |
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Author |
Mearns, G. |
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Title |
Developing autonomous ownership: A grounded theory study of how registered nurses working in aged care are advancing their nursing practice |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Auckland University of Technology Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Nurse practitioners; Geriatric nursing; Older people; Registered nurses |
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Abstract |
The introduction of nurse practitioner registration into New Zealand in 2001 was heralded as a move that would open up a wealth of opportunities for registered nurses to extend their practice into more independent roles and to provide a client-centred health service. It was also seen as a way to retain experienced registered nurses in the clinical practice area by providing a credible clinical career pathway. If nurse practitioner's are to meet these expectations, then, the author suggests, it is important to understand the processes that encourage or discourage nurses from advancing their practice. One of the early scopes of practice to be introduced was nurse practitioner with an endorsement in aged care scope of practice. Grounded theory was the method used to generate an explanation of how registered nurses working in aged care were preparing for the introduction of nurse practitioner roles. An analysis of early data highlighted codes around registered nurses in aged care extending and advancing their practice rather than preparing specifically for the nurse practitioner role. The research question for this study was: 'How are registered nurses in aged care advancing their nursing practice?' Semi-structured interviews were used to collect data from ten experienced registered nurses working in aged care clinical practice settings ranging from secondary hospital facilities, to community settings and residential care villages. Dimensional analysis of the data eventually generated three major conceptual categories: 'ownership of nursing', 'extending practice', and 'moving out of a comfort zone'. Of these, 'ownership of nursing' was identified as the core construct that linked the other categories together. The substantive theory that explains how registered nurses in aged care advance their clinical practice is 'developing autonomous ownership'. Nurses who develop autonomous ownership of nursing are more likely than other nurses to move out of a current comfort zone and advance their practice into more independent roles that suit their autonomous ownership of nursing. This study identified important contextual factors and conditions that support the development of an autonomous ownership of nursing and that subsequently facilitate advancing nursing practice. These include creating supportive environments, organisational commitment to advanced nursing practice roles, visible nursing leadership, congruence between organisational and nursing philosophies, interdisciplinary collaboration and participating in postgraduate education. The author suggests that the significance of this study is that it generated a theory about the processes that encourage or discourage nurses from preparing for, and progressing into, advanced nursing practice roles such as nurse practitioner. |
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Call Number |
NRSNZNO @ research @ |
Serial |
585 |
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