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Author |
Fitzpatrick, A. |
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Title |
Nurse meeting another: cultural safety in nursing practice |
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Year |
1997 |
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Victoria University of Wellington Library, Waiarik |
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This research project, a descriptive study using narratives, explored the application of cultural safety theory and philosophy to clinical nursing practice. This application was illustrated through the stories of four experienced Pakeha,Tauiwi registered nurses in Aotearoa/New Zealand, who described their realities of applying cultural safety to daily clinical practice. The incentive for this study had been identified in light of the current political climate, pragmatic realities and in keeping with the current state of knowledge.Cultural safety was first identified by Maori nursing students and subsequently described and articulated by Maori nurses, as being a potential solution to improving Maori health statistics in Aotearoa/New Zealand. Many Maori and Pakeha/Tauiwi in this country accept that the Treaty of Waitangi, a covenant signed between Maori and the Crown in 1840, is the incentive for giving cultural safety status and credibility. While the Nursing Council of New Zealand has supported this concept and made it a requirement for all nursing education, there is little literature written concerning its application to practice from a Pakeha/Tauiwi perspective.The perceptions and insights of these nurses were heard when they were invited to describe how they saw cultural safety as part of their daily clinical practice and recount their struggles, realities, practice and experience. The literature review supported the use of narratives as an appropriate method for this study. The philosophy and assumptions of narrative appear to match the oral tradition of nursing and thus it was considered possible to contemplate the fit of narrative to nursing research.The stories of these nurses, gave examples of best nursing practice in which cultural safety was integral to practice, and provided exemplars of possible beginnings and possible endings. The depiction of cultural safety in practice surfaced as the weaving of four themes which were consistent in all the stories – themes of reflection, reverencing, the environment, and hidden blessings and healing. The research evidence suggested that cultural safety was visible in practice in many diverse ways; it emphasised the complexity of the concept; accented its evolving status; and identified a relative consistency in defining cultural safety despite the varied contexts of practice.Although this study was limited by the small sample, the findings indicated that there were potential implications for nursing education, research, nurses and nursing practice as well as for other health care providers working in the current health care system. They suggested that actions from nurse educators, nurse managers, health care managers and clinical nurses themselves, would be needed to ensure that cultural safety continued to be part of nursing practice and contribute to the improvement of all health statistics in this country as well as to encourage an increased development in the focus on Maori health issues.Further nursing research suggested by the findings include studies to appraise cultural safety from a patient's perspective, and consideration given to the evaluation and assessment of nurses and their culturally safe practice. In addition, exploration and research could ascertain the benefits and rewards of culturally safe practice and identify ongoing educational needs as well as examining the views of other members of the multi-discipline team |
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NRSNZNO @ research @ 204 |
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204 |
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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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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 |
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203 |
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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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1995 |
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Abbreviated Journal |
Private Bag, 92024, Auckland |
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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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NRSNZNO @ research @ 202 |
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202 |
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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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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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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 – its impact on practice |
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1996 |
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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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NRSNZNO @ research @ 200 |
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200 |
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Author |
Thomson, M. |
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Title |
A study of the position of staff-sister in a New Zealand public hospital with special focus on supervision |
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Year |
1974 |
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Victoria University of Wellington Library |
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This study examines demographic data on the primary subject, the staff sister. Data on trainee nurses was also used to give meaning by comparing the two positions and to describe both sides of the staff-sister; trainee nurse relationship. Data on the staff sister's job, her present and future orientations, satisfaction and problems are included |
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NRSNZNO @ research @ 20 |
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20 |
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Author |
Wells, C.C. |
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Title |
Our dreams |
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1998 |
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Victoria University of Wellington Library |
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There has been a great deal written about the efforts of the nursing profession to achieve full professional status but little about individual nurses' aspirations in seeking this goal. A group of 6 co-researchers, myself included, looked at this perceived gap in nurses' dreams for the profession.The philosophical underpinnings of the research were feminist and reflected postmodern feminist and some radical feminist concepts. This philosophical positions guided our research to uncover the knowledge of how we actively construct ourselves into dominant social values. This means we were searching for how our dreams were constructed and how we reflected the values of society in the way we produced our dreams. Peace and Power (Chinn & Wheeler, 1989) was used to guide the group interaction and Memory-Work (Hague, 1987) for data collecting and analysis. The co-researchers wrote individual stories about their dreams for the nursing profession. Collective analysis of the stories occurred in order to uncover the was in which the dreams were constructed. From this collective analysis the individual co-researchers redrafted their stories. Each redraft contained new insights, motives and actions of ourselves and others, forgotten experiences and inconsistencies, as a means of identifying and questioning dominant ideologies. The aim was to move towards empowerment through making the unconscious conscious.Four common dreams emerged from analysis of the stories: the first was that individual nurses want full professional status and autonomy; the second asked the nurses to care and support each other; a high standard of patient and nursing-focussed care was the third dream; and the fourth was for continuing education and knowledge to be shared between nurses. Although the dreams were common across the group it was found that the dreams varied in their construction. The dreams for each group member reflected multiple realities that emerged from different contexts, influenced by historical and socially dominant cultural values.Through studying and theorising our dreams for the nursing profession, we increased our understanding of how they were shaped so that we were able to initiate change and make our dreams become a reality. This has implications for the nursing profession. We live our lives collectively, as nurses and women, as others influence our being and reality. Although others influence us, it is each individual nurse who contributes to actively construct her/himself in to the dominant cultural values held by society and therefore up to each individual to initiate change. If nurses are able to make dreams a reality then positive changes will occur within the profession; I.e. decreased staff turnover, increased morale and increased quality in patient care |
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NRSNZNO @ research @ 2 |
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2 |
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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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1995 |
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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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NRSNZNO @ research @ 199 |
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199 |
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Author |
Corbett, A. |
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Title |
A study into the role of the school nurse |
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Miscellaneous |
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It was believed that the Registered Nurse in the position of school nurse had much to contribute with assisting teachers with health education, health promotion; and able to offer personal counseling and assistance with family and personal problems of individual problems. A nurse who approached the researcher on a matter of pay rates was not used in this way. Was this a general trend in secondary schools? What exactly was the work of the school nurse? Was there any commonality between the work of school nurses in secondary schools in the Hamilton area? Were all schools nurses qualified as Registered Nurses? The role of the school nurses therefore appeared to be a suitable topic for a research project |
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NRSNZNO @ research @ 198 |
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198 |
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Author |
Nelson, C.M. |
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Title |
Nursing the stranger you know |
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1998 |
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Victoria University of Wellington, Library – Depar |
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Nursing the Stranger You Know demonstrates how combining aspects of nursing theory, the work of Ken Wilber, a leading writer in the field of transpersonal psychology and my own reflections have enhanced how I am able to experience and practice nursing in a primary health care setting.This study acknowledges and values the power of the connections which link us all together. The greatest strength of this work is that it shows, through the use of personal writing, how it is possible to nurse beyond the present and beyond the obvious when clinical, theoretical and self knowledge are all equally respected and incorporated into nursing practice |
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NRSNZNO @ research @ 197 |
Serial |
197 |
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Author |
Walker, J. |
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Title |
Learning physical assessment skills |
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Year |
1995 |
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Author |
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Nursing students have only recently learnt in-depth physical assessment skills within degree programmes in New Zealand. The purpose of this qualitative study was to describe the experience of learning physical assessment skills for the first time from the student's experience. In exploring this experience it was hoped to uncover some of the factors, beneficial or not, which influence their learning process. Data was collected by two methods. Firstly through two non-participant observations of a class of sixteen pre-registration male and female nursing students at an urban tertiary institute. Secondly through taped in-depth interviews with a female and a male student, from the group, individually and then together. The data was analysed using coding categories suggested by Bogdan and Biklen (1992) and emerging themes related to the process of learning new knowledge and skills. The four themes identified were: students working at learning, tutors facilitating learning, students facilitating learning and learning in clinical practice |
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NRSNZNO @ research @ 196 |
Serial |
196 |
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Author |
Walker, J. |
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Title |
Learning psychomotor skills: Is Kolb's experiential learning cycle effective? |
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1994 |
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Marjorie Manthei, Academic Division Manager, Chris |
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The move to nursing degrees has encouraged educators to use student centredteaching methods which develop problem solving skills, critical thinking andreflection. Kola's Experiential learning cycle is proposed as one method to developsome of these skills. The study compared the effectiveness of three differentmethods of teaching the instillation of eye drops and application of an eye pad. Asample of 73 volunteers from a Diploma of Nursing programme were systematicallyassigned to one of three groups. The modified experimental design consisted of acontrol group (tutor demonstration and student practice), Kolb's group (teachingusing the experiential cycle) and the SDL group (self directed learning using writteninformation with no tutor instruction or feedback). Participants rated their confidence,competence and the amount of thinking, analysis, guidance and problem solvingbefore and after each method.Results for instilling eye drops indicated that there were no significant differences onthe pre-test ratings and a marginally significant difference (p=0.06) on the post testratings across the teaching methods. Results for the eye pad showed no significantdifferences on pre-test or post-test ratings across the methods. Students learnt by allmethods and the differences, if there were any, were not large enough to bedetected in this study. There was a significant difference in problem solving and tutorguidance across the methods due to the low ratings of the SDL group. There was nosignificant difference in thinking, analysis or partner guidance across the methods |
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NRSNZNO @ research @ 195 |
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195 |
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Author |
Walker, J. |
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Title |
Co-operative learning: an effective teaching method for tertiary education? |
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1996 |
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Author, Christchurch Polytechnic Library |
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Tertiary education aims to develop specialist knowledge and the graduates' ability toapply the knowledge and skills to function effectively in their chosen career or work.Employers have criticised tertiary education when graduates cannot workco-operatively or independently in the work setting and teachers look for alternativesto lecturing to help develop these abilities. Cooperative learning (CL) is one suchmethod and this paper reports on a literature review and pilot study which exploredthe use of CL in a tertiary setting. The study was guided by three questions: 1) Whatarea the teacher's conceptions of effective learning and teaching? 2) How are theyusing CL and what is their role? 3) How are they assessing CL classes?Data was collected through in-depth interviews, using semi-structured questions,with three female and one male teacher from different disciplines in an urbanpolytechnic. Responses to each question were analysed thematically for recurringcodes and these were grouped into categories. Effective teaching was seen aswhere teachers facilitated the learning process by selecting appropriate teachingmethods, fostering classroom climate and monitoring learning. Effective learning waswhere students were actively engaged in the learning process and demonstratedtheir understanding and application of knowledge and skills. CL was used in avariety of ways and their role was to use strategies to foster the learning processand monitor learning. Assessment involved both individual and group presentations.Issues related to cooperative learning are discussed and recommendations forteaching made |
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NRSNZNO @ research @ 194 |
Serial |
194 |
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Author |
Griffin, E.; Walker, J. |
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Title |
Best health care practices for women with disabilities from the perspective of three community health practitioners |
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Miscellaneous |
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There is a dearth of information about community-based health promotion ortreatment services for women with disabilities in New Zealand. Little is also knownabout what health care providers perceive are the best ways to provide theseservices.This study examines the question “ What are the best health care practices fordisabled women?” An exploratory, descriptive approach was used to interview threehealth professionals (one nurse and two doctors) working in two different generalpractices, regarding their perspective of this question. These health professionalswere identified by women with disabilities as providing a quality service to them.Data was collected on their philosophy of care, definitions of disability, professionaleducation and range of primary medical and nursing care provided. The data wasanalysed for recurring themes related to each of the semi-structured interviewquestions. The characteristics of 'best health care' were found to include:client-centered care, communication and equality of care. The findings have beendiscussed in relation to the recommendations from the 1993 National AdvisoryCommittee on Core Health and Disability Support Services and feminist literature |
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NRSNZNO @ research @ 193 |
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193 |
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Author |
Walker, J. |
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Title |
The transition to registered nurse: the experience of a group of New Zealand degree graduates |
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Journal Article |
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Year |
1998 |
Publication |
Nursing Praxis in New Zealand |
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13 |
Issue |
2 |
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36-43 |
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Since 1991, nursing profession in New Zealand has primarily been through a three year programme. The purpose of this study was to explore the issues faced by a group of degree graduates in their first year of registered nurse practice and to identify if the degree graduatesoutcomes (such as critical thinking, problem solving, reflection on practice, research, independent learning, and using cultural safety knowledge) had mediated this transposition process. Purpose sampling was used to invite five female graduates to take part in two focusgroups, one held at months and the other at 9 months after starting work. Qualitative data were collected using semi-structured questions and the taped interviews were analysed for themes. Five themes were identified: accepting responsibility, accepting their level of knowledge, becoming a team member, professional standards, and workplace conditions. Graduates were using their cultural safety knowledge but they perceived their knowledge of research was linked to further academic. Their ability to critique their own practice was evident but they found it difficult to challenge their colleagues' practice and the wider agency culture. Implications of the study are discussed in relation to nursing education and preceptor programmes and areas for further research are indicated |
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Call Number |
NRSNZNO @ research @ 192 |
Serial |
192 |
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