Haji Vahabzadeh, A. (2018). Optimal Allocation of Intensive Care Unit nurses to Patient-At-Risk-Team. Doctoral thesis, University of Auckland, Auckland.
Abstract: Explains the need for nurse-led Patient-at-Risk-Teams(PART) to prevent unnecessary ICU admissions. Investigates which nurse allocation policy between PART and ICU would result in the best outcomes for patients and hospitals. Provides econometric models to estimate the impact of critical care nurses on hospital length of stay. Proposes queueing and simulation models to obtain the optimal nurse allocation policy for minimising the ICU mortality rate. Validates proposed models at Middlemore Hospital from 2015 to 2016. Estimates the financial and mortality impact of allocating another nurse to PART per shift.
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Lui, D. M. K. (2003). Nursing and midwifery attitudes towards withdrawal of care in a neonatal intensive care unit: Part 2. Survey results. Journal of Neonatal Nursing, 9(3), 91–96.
Abstract: Discontinuation of life support measures for an extremely low birthweight or very premature baby is controversial and difficult for both the parents and the healthcare professional involved in caring for the infant. This study seeks to investigate the attitude of nurses and midwives to the withdrawal of care from sick neonates. Part 1 reviewed the literature on this subject. Part 2 reports the results of a survey carried out in a New Zealand NICU.
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Bell, J. (2007). Blood glucose control using insulin therapy in critically ill adult patients with stress hyperglycaemia: A systematic review.
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Pirret, A. M. (2005). The use of knowledge of respiratory physiology in critical care nurses' clinical decision-making. Ph.D. thesis, , .
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Morrison, M. (2003). Posthuman pathology: A postmodern art project located in critical care. Ph.D. thesis, , .
Abstract: The author's art project “Posthuman Pathology” is a postmodern examination of the resolutely modernist culture of critical care medicine. She uses conceptual art practices in conjunction with the techniques of anti-aesthetics in order to dismantle, open out and critique ideas which are foundational to the culture of critical care.
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Patel, R. (2006). Evaluation and assessment of the online postgraduate intensive care nursing course. Ph.D. thesis, , .
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Blanchard, D. L. (2006). Developing the place and role of family within the culture of critical care nursing: An action research approach. Ph.D. thesis, , .
Abstract: This research examines how nurses negotiate the context of the Intensive Care Unit (ICU) while working with families. The action research described in this thesis developed through a series of meetings and conversations where the conversations supported the reflexive intent of the research. In commissioning the research, the design of the meetings and conversations were as a series of overlapping actions. Data collection and data analysis occurred in the action research by meetings, reflective conversations, ad libitum observations, and in a research journal. Conceptual maps explain the progress and findings of the research in this thesis while categories distilled from the conversations also support the findings in the research. The Family Action Research Group that was established within this project proposed a Family Assessment Form for the family to provide an assessment of themselves and the patient. Implementing this assessment tool demonstrated that clear information was needed for the family in the ICU. Findings in this research focus on developing action research and family care in ICU. Findings also focused on the role of the researcher being of and not being of the context where action research is undertaken. Recommendations include staff examining relationships for potential asymmetries and seeking ways to address these to support families and staff. Suggested strategies for developing action research in a clinical context include detailed planning, clear focusing, transparency of data, and working to explain change initiatives through the research are also included.
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McNamara, N. (2007). The meaning of the experience for ICU nurses when a family member is critically ill: A hermeneutic phenomenologcial study. Ph.D. thesis, , .
Abstract: This study provides insight into the experience of being an ICU nurse and relative of a critically ill patient. Analysis of data from interviews of four ICU nurses who had experienced having a family member admitted to ICU brought up several themes. These included: a nurses' nightmare, knowing and not knowing, feeling torn, and gaining deeper insight and new meaning. Recommendations for organisational support for ICU nurse/relatives, and education for staff are made, based on the findings.
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Dredge, A. (1999). An insider's view of professional nursing and care management of the critically ill patient. Vision: A Journal of Nursing, 5(8), 13–16.
Abstract: This article explores the role of the registered nurse (RN) in the critical care environment. It presents the Intensive Care Unit (ICU) as a unique environment, with a specific relationship to technology, and a history that mirrors scientific development. It explores the tensions for a caring profession with a distinct culture practising in a highly medicalised, acute environment, and affirms the value of quality human care.
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Turner, C. L. E. A process evaluation of a shared leadership model in an intensive care unit. Ph.D. thesis, , .
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Ho, T. (2000). Ethical dilemmas in neonatal care. Kai Tiaki: Nursing New Zealand, 6(7), 17–19.
Abstract: The author explores possible approaches to the ethical dilemma confronting nurses of critically ill premature infants with an uncertain or futile outcome despite aggressive neonatal intensive care. A case history illustrates the issues. The morality of nursing decisions based on deontological and utilitarian principles is examined, as are the concepts of beneficence and non-maleficence. A fusion of virtue ethics and the ethic of care is suggested as appropriate for ethical decision-making in the neonatal intensive care environment.
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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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Roberts, C. (2007). The influence of nursing culture on family visiting in adult intensive care units. Ph.D. thesis, , .
Abstract: This dissertation considers the implications of the relationship between nurses and the patient's family, when family members visit intensive care units (ICUs) following the acute admission of a relative there. In particular it explores the issues of power and control, nurses might have in this setting, the culture that supports that, and the implications this has for practice in the New Zealand context. A comprehensive literature review on the perspective of nurses in relation to relatives visiting adult intensive care units was conducted. The author concludes that nurses modify policies related to visiting access for family members to suit themselves, and the needs of their patient. Nurses use a variety of tactics to maintain a position of power and control by looking out for themselves first, their patient second, and relatives third. The need of the patient and their families is not well understood by nurses, and nurses feel they have inadequate skills to cope with the needs and stresses of visiting relatives. The author suggests that for nurses to provide family focused care in ICU they must develop a therapeutic relationship with all concerned. ICU nursing culture affects nurses ability to focus on caring for their patients and their families. Nurses in ICU appear to need to maintain power and control over their environment but further research is needed to identify the current situation in New Zealand ICUs.
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Fielding, S. (2006). Learning to do, learning to be: The transition to competence in critical care nursing. Ph.D. thesis, , .
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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Fogarty, K. (2005). The assessment of competence in the novice nurse in the adult intensive care unit. Ph.D. thesis, , .
Abstract: This dissertation explores the assessment of nurses' clinical competence in the adult ICU setting. Specifically, methods for the assessment of competence are critiqued for their practical application to the novice nurse with less than six months experience in ICU. The assessment methods considered are continuous clinical assessment, self-assessment, peer review, objective structured clinical examination (OSCE), portfolio and computer assisted assessment. Several criteria are applied to the methods including the ability of each method to assess skills, knowledge and attitudes or values. Each method is critiqued for its implications in terms of cost and staffing resource, benefits and barriers to implementation. In addition, reliability and validity issues are considered for each method. The outcome of this exploration is the recommendation of a combination of methods; namely, portfolio and OSCE, for the assessment of competence in the ICU novice. The author concludes that this finding enhances current understanding within the ICU specialty of the multidimensional nature of competence assessment.
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