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Gardner, A., Hase, S., Gardner, G., Dunn, S., & Carryer, J. B. (2008). From competence to capability: A study of nurse practitioners in clinical practice. Author copy available 12 months after publication from QUT ePrints, 17(2), 250–258.
Abstract: This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. A secondary analysis of data obtained from the interviews with 15 nurse practitioners working in Australia and New Zealand was undertaken. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. This study suggests dimensions of capability need to be considered in the education and evaluation of nurse practitioners.
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Hughes, F., Duke, J., Bamford-Wade, A., & Moss, C. (2006). Enhancing nursing leadership through policy, politics, and strategic alliances. Nurse Leader, 4(2), 24–27.
Abstract: This paper looks at the links between nursing roles and health policy in New Zealand. Strategic alliances between key professional leaders in different nursing roles can help the profession by directly influencing policy development and implementation. This form of policy entrepreneurship is an important component of professional leadership.
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Rydon, S. E. (2005). The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services. International Journal of Mental Health Nursing, 14(2), 78–87.
Abstract: In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for more research that reflects the perspective of users.
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Stone, P. W., Tourangeau, A. E., Duffield, C. M., Hughes, F., Jones, C. A., O'Brien-Pallas, L., et al. (2003). Evidence of nurse working conditions: A global perspective. Policy, Politics, & Nursing Practice, 4(2), 120–130.
Abstract: The purpose of this article is to review evidence about nurse workload, staffing, skill mix, turnover, and organisational characteristics' effect on outcomes; discuss methodological considerations in this research; discuss research initiatives currently under way; review policy initiatives in different countries; and make recommendations where more research is needed. Overall, an understanding of the relationships among nurse staffing and organisational climate to patient safety and health outcomes is beginning to emerge in the literature. Little is known about nursing turnover and more evidence is needed with consistent definitions and control of underlying patient characteristics. Research and policy initiatives in Australia, Canada, New Zealand, and the United States are summarised.
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Clendon, J., & White, G. E. (2001). The feasibility of a nurse practitioner-led primary health care clinic in a school setting: A community needs analysis. Journal of Advanced Nursing, 34(2), 171–178.
Abstract: The aim of this study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a New Zealand primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses were the most appropriate nurses to lead such a clinic. Utilising a community needs analysis method, data were collected from demographic data, 17 key informant interviews and two focus group interviews. Analysis was exploratory and descriptive. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the public health nurse was less than anticipated and that community expectations were such that for a public health nurse to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. The authors conclude that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.
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Harding, T. S., North, N., & Perkins, R. (2008). Sexualizing men's touch: Male nurses and the use of intimate touch in clinical practice. Research & Theory for Nursing Practice, 22(2), 88–102.
Abstract: Drawn from a larger study, this article reports the experiences of a group of male nurses regarding the use of intimate physical touch. Using discourse analysis, interview data from 18 male nurses were analysed and related to existing text on men as nurses. The analysis reveals that although touch is important in nursing care, it is problematic for men because discourses have normalised women's use of touch as a caring behaviour and have sexualised men's touch. Participants described their vulnerability, how they protected themselves from risk, and the resulting stress. The complicity of nurses in sexualising men's touch and the neglect of educators in preparing men for providing intimate care are revealed. A paradox emerged whereby the very measures employed to protect both patients and men as nurses exacerbate the perceived risk posed by men carrying out intimate care. The authors suggest that deconstructing and reframing prevailing discourses around nursing, gender, and caring involving touch can help to legitimise men's involvement in physical caring.
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Kool, B., Thomas, D., Moore, D., Anderson, A., Bennetts, P., & Earp, K. (2008). Innovation and effectiveness: Changing the scope of school nurses in New Zealand secondary schools. Australian & New Zealand Journal of Public Health, 32(2), 177–180.
Abstract: The aim of this research was to describe the changing role of school nurses in eight New Zealand secondary schools from low socio-economic areas with high Pacific Island and Maori rolls. An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland(2002-05) was made. Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. The researchers conclude that school nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. The researchers go on to say that co-ordination of school nurses either at a regional or national level is required.
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Curtis, K., & Donoghue, J. (2008). The trauma nurse coordinator in Australia and New Zealand: A progress survey of demographics, role function, and resources. Journal of Trauma Nursing, 15(2), 34–42.
Abstract: An initial profile of the demographics and current practice of Australian trauma nurse coordinators (TNCs) was conducted in 2003. The study identified common and differing role components, provided information to assist with establishing national parameters for the role, and identified the resources perceived necessary to enable the role to be performed effectively. This article compares the findings of the 2003 study with a 2007 survey, expanded to include New Zealand trauma coordinators. Forty-nine people, identified as working in a TNC capacity in Australia and New Zealand, were invited to participate in February 2007. Participation in the research enabled an update of the previously compiled Australia/New Zealand trauma network list. Thirty-six surveys (71.5% response rate) were returned. Descriptive statistics were undertaken for each item, and comparisons were made among states, territories, and countries. Participants reported that most of their time was spent fulfilling the trauma registry component of the role (27% of total hours), followed by quality and clinical activities (19% of total hours), education, and administration. The component associated with the least amount of time was outreach (3% of total hours). Although the proportion of time has almost halved since 2003, TNCs still spend the most time maintaining trauma registries. Compared to the 2003 survey, Australian and New Zealand TNCs are working more unpaid overtime, spending more time performing quality and clinical activities and less time doing data entry. Despite where one works, the role components identified are fulfilled to a certain extent. However, the authors conclude that trauma centres need to provide the TNC with adequate resources if trauma care systems are to be optimally effective
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McKenna, B., O'Brien, A. J., Dal Din, T., & Thom, K. (2006). Registered nurses as responsible clinicians under the New Zealand Mental Health (Compulsory Assessment and Treatment) Act 1992. International Journal of Mental Health Nursing, 15(2), 128–134.
Abstract: The objectives of this research were to determine how many registered nurses are working as 'responsible clinicians', under what phases of the legislation they are functioning, and to describe the enabling processes and barriers to nurses undertaking this statutory role. An anonymous descriptive survey was distributed to the 11 nurses who were currently responsible clinicians as well as five senior nurses selected from each of the 21 district health boards and the Auckland Regional Forensic Psychiatry Services (n=121). The response rate was 88.4% (n=107). The survey questioned respondents on statutory roles currently undertaken. Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain it. They were also asked which competencies of the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. Of the approximately 395 responsible clinicians nationally, 11 (2.8%) are nurses. Most nurses viewed the role as legitimate. However, many were unaware of competencies for the role and credentialing processes, and were somewhat ambivalent about achieving the role due to current workload, role conflict and lack of remuneration. Competency deficits were highlighted. The authors conclude that there are grounds to encourage nurses as responsible clinicians given the intent of the legislation. This will require the promulgation of appropriate mental health policy, and a concerted effort by major stakeholders in mental health service delivery.
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O'Brien, A. P., Boddy, J. M., Hardy, D. J., & O'Brien, A. J. (2004). Clinical indicators as measures of mental health nursing standards of practice in New Zealand. International Journal of Mental Health Nursing, 13(2), 778–788.
Abstract: This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritised in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 district health board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. The authors discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.
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McLeland, A., & Williams, A. (2002). An emancipatory praxis study of nursing students on clinical practicum in New Zealand: Pushed to the peripheries. Contemporary Nurse, 12(2), 185–193.
Abstract: The purpose of this qualitative study was to analyse the learning experiences of nine nursing students on clinical placement in New Zealand. The students were in their third and final year of their baccalaureate nursing degree. The study specifically examined what impinged upon their learning experience in the clinical venue. Data was obtained from interviewing the students, initially individually and finally in a focus group. Themes emerged through words and concepts as the data was analysed. The themes included powerlessness; marginalisation; the move from a holistic to a reductionist approach in care; the exploitation of minority students and the myth of praxis. Clinical practice was a time for nursing students to apply their knowledge to their practice, and to gain experience and confidence. Their clinical practice was normally a positive experience, but, each student spoke of the occasional negative episode. These left them with feelings of powerlessness and marginalisation. The Maori students felt exploited. The students were concerned about the lack of time to debrief at the end of the day, and to share their experiences with their educator and colleagues. The students' negative experiences were often the result of a clinical practitioner's high workload, under resourcing and the nurse educator's unavailability.
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Spence, D. (2001). Prejudice, paradox, and possibility: Nursing people from cultures other than one's own. Journal of Transcultural Nursing, 12(2), 100–106.
Abstract: This article provides a brief overview of the findings of a hermeneutic study that explored the experience of nursing people from cultures other than one's own. The notions prejudice, paradox, and possibility are argued to describe this phenomenon. Nurses in New Zealand are being challenged to recognise and address racism in their practice. Yet, the implementation of cultural safety in nursing education has created tension within the profession and between nursing and the wider community. As nurses negotiate the conflicts essential for ongoing development of their practice, the play of prejudice, paradox, and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses. Nurses are challenged to continue their efforts to understand and move beyond the prejudices that otherwise preclude the exploration of new possibilities.
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Litchfield, M. (1999). Practice wisdom. Advances in Nursing Science, 22(2), 62–73.
Abstract: The paper is the report of two cumulative research projects studying the nature of nursing knowledge and methodology to develop it. They were undertaken as theses for masters and doctoral degrees at the University of Minnesota, USA. Nursing knowledge is depicted as relational: an evolving participatory process of research-as-if-practice of which 'health' (its meaning), dialogue, partnership and pattern recognition are threads inter-related around personal values of vision and community.
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Kennedy, W. (2007). Professional supervision to enhance nursing practice. Available online from Eastern Institute of Technology, 14(2), 3–6.
Abstract: This article examines the concept of clinical supervision as “professional supervision”. Professional supervision contains many elements, is structured and not without effort. Fundamentally it is about being safe and professional. 'Reflective learning' and 'Live/tutorial' models are reviewed in different contexts for assisting nurses work through everyday issues, conflicts and problems of their role. The author concludes that regardless of which model is used there are benefits for safety and professionalism.
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Litchfield, M. (1986). Between the idea and reality. Nursing Praxis in New Zealand, 1(2), 17–29.
Abstract: A paper presented as one of the four “Winter Lecture Series” hosted by the Nursing Studies unit of the Department of Education, Victoria University of Wellington. It is a critique of “ The Nursing Process” referred to commonly in nursing education programmes. It challenges the usefulness for nursing of the linear sequence of steps of assessment, diagnosis, planning, intervention and evaluation.
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