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Macfarlane, K. (2006). Communicating changes in a patient's condition: A critical incident approach. Ph.D. thesis, , .
Abstract: This study explores how registered nurses working within the acute surgical ward environment of a New Zealand hospital communicate changes in a patient's condition. The purpose of this research study was to examine the processes, communication techniques and behaviours that nurses use, in order to determine the critical requirements for registered nurses to effectively communicate changes in patients' conditions to doctors. The critical incident technique developed by Flanagan (1954) was adapted and used to explore incidents that occurred when six registered nurses working in acute surgical wards communicated a change in a patient's condition to a doctor. Communication is an integral part of everyday activity. This study has shown an assessment process occurs before communication can take place. A nurse's concern for a patient's condition initiates the assessment process. A judgement is formed from the nurse's concern that a patient's condition has changed. Judgements take into account multiple ways of knowing including pattern recognition, empirical knowing and intuition. Institutional protocols also affect judgements and the ability of a nurse to ensure support is received for the patient's well being. The communication process is initiated for two reasons, to support the patient, and to support the nurse in providing care for the patient. Significant in determining the need for support is the action required that might be outside the nurse's scope of practice. The response should address the nurse's concern and take into account the importance of the relationship, trust between all parties, respect of each other's positions and knowing team members and their capabilities. Understanding these aspects of the communication process should enhance nurses and doctors abilities to effectively communicate regarding a change in a patient's condition.
Keywords: Communication; Clinical assessment; Physicians; Nursing; Relationships
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Wong, G., & Sakulneya, A. (2004). Promoting EAL nursing students' mastery of informal language. Nursing Praxis in New Zealand, 20(1), 45–52.
Abstract: This article describes the development, delivery and evaluation of a pilot programme designed to help nursing and midwifery students from Asian and non-English speaking backgrounds improve their conversational skills in practice settings. Many such students, although previously assessed as competent in English, find that communication with patients and their families, and other health professionals is difficult. The study was conducted in a large tertiary educational institution in a major metropolitan centre. Each week for a period of 11 weeks students participated in an interactive session. Content for these was based on areas highlighted by a needs assessment involving interviews with both students and lecturers, and was subject to ongoing modification in response to feedback from participants. Evaluation questionnaires completed at the conclusion of the series indicated that students perceived the impact as positive. Students who attended regularly and were actively involved in the practice activities described gains in communication skills. From this it was concluded that further development of the pilot scheme was warranted in order to benefit English as an additional language (EAL) students enrolled in nursing and midwifery courses
Keywords: Communication; Asian peoples; Education; Nursing
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Moir, C., & Baby, M. (2022). Managing violence and aggression: graduate-entry nursing students' responses to pre-emptive communication skills education. Kai Tiaki Nursing Research, 13(1), 9–18.
Abstract: Argues that teaching de-escalation skills early in the nursing programme is vital for student safety and later retention in the nursing workforce. Sets out to determine the efficacy of communication training to teach nursing students agression-management skills while on clinical placement. Designs a quasi-experimental design using pre- and post-tests of communication competence following an education module delivered as part of the curriculum.
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Brunton, M., Cook, C., Walker, L., & Clendon, J. (2017). Where are we?: workplace communication between RNs in culturally-diverse healthcare organisations; Analysis of a 2-phase, mixed-method study: a report prepared for the New Zealand Nursing Education and Research Foundation. Wellington: Massey University.
Abstract: Examines cultural influences on perceptions and practices of cross-cultural communication among registered nursing staff from diverse ethnicities in NZ. Employs an exploratory approach to obtain qualitative feedback by means of semi-structured interviews with 36 Internationally Qualified Nurses (IQN) and 17 NZ Registered Nurses (NZRN). Uses data from the interviews to construct a questionnaire survey to seek responses from a random national sample of RNs.
Keywords: Communication in nursing; Registered nurses; Surveys
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Lu, H., & Maithus, C. (2012). Experiences of clinical tutors with English as an additional language (EAL) students. Nursing Praxis in New Zealand, 28(3), 4–12.
Abstract: Conducts a study of the perceptions of new nursing graduates, with English as an additional language (EAL), on how they developed spoken language skills for the clinical workplace. Interviews 4 clinical tutors to elicit their views on the language development of EAL students. Outlines the themes that emerged from the tutor interviews.
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Bunn, S. (2007). An exploration of the transition of patients from intensive care to the ward environment: A ward nursing perspective. Ph.D. thesis, , .
Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.
Keywords: Clinical decision making; Nursing; Communication
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Polaschek, N. (2003). Negotiated care: A model for nursing work in the renal setting. Journal of Advanced Nursing, 42(4), 355–363.
Abstract: This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. Materials from several streams of literature are used to conceptualise the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualised by viewing the renal setting as a specialised social context constituted by a dominant professional discourse and a contrasting client discourse. While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. The author concludes that within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanise contemporary medical technologies by responding to clients' experiences of illness and therapy.
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Cook, C., & Brunton, M. (2014). The influence of the Cartwright Report on gynaecological examinations and nurses' communication. Nursing Praxis in New Zealand, 30(2), 28–38.
Abstract: Reports findings from semi-structured interviews with 6 nurses and 7 women patients at a sexual health clinic where the women reported positive experiences of speculum examinations. Combines data with that from interviews with 16 patients and 16 clinicians regarding positive examinations, and analyses data to identify which clinical communication strategies were used, and how the women responded. Highlights the legacy of the Cartwright Report of the Cervical Cancer Inquiry of 1987/88.
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