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Atherfold, C. (2008). Will someone walk with me? A case study exploration of graduate nurses' perceptions of the preceptored experience. Ph.D. thesis, , .
Abstract: The transition from student to registered nurse is a challenging and often stressful time in a nurse's career. This thesis is a case study research project that explores the graduate nurses' perceptions of preceptorship as a strategy to support this transition at Lakes District Health Board (DHB). As a provider of graduate nurse programmes since 1995, Lakes DHB has provided preceptorship for the nurse in the initial period of clinical practice. Annual evaluation by questionnaire identified that this has been applied in a range of ways in different clinical settings with varying degrees of effectiveness. Further inquiry into graduate nurses' perceptions of the preceptored experience during the first twelve weeks of practice within Lakes DHB forms the basis of this research project. The intention is to utilise this insight to further inform the development of preceptor education programmes and application of the preceptor role in the practice setting. Using the case study research method, data has been collected from fourteen participants using semi-structured interviews, focus groups and secondary data from the previous year's questionnaire undertaken by preceptors and graduate nurses. Thematic analysis of the data has resulted in two categories, each with three associated themes. The first category relates to functional factors in the way the preceptorship role is applied. This explores the role of the Clinical Nurse Educator (CNE), organisation within the unit and the teaching of clinical skills. The second category relates to psychosocial considerations and includes the graduate's sense of being scared and advocacy of the preceptor, socialisation and team support, and the preceptor's own experience as a registered nurse. Recommendations from the research include the allocation of a dedicated preceptor selected with consideration for relational ability; complementary rostering and workload allocation to ensure that the preceptor and graduate nurse work together; early notification when preceptor arrangements break down; implementation of a clinical coaching plan; and strengthening the CNE's role as a leader facilitating and supporting preceptorship in the units. Opportunities for further research that arise from the study include the perceptions of the preceptors and the nursing leadership in clinical areas. Structuring the application of preceptorship, to ensure that all of these aspects are woven throughout the graduate nurse's transition results in Korowai Aroha, a cloak of covering for a supported transition that facilitates the development of practice.
Keywords: Preceptorship; New graduate nurses
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Goodyear-Smith, F., & Janes, R. (2008). New Zealand rural primary health care workforce in 2005: More than just a doctor shortage. Australian Journal of Rural Health, 16(1), 40–46.
Abstract: The aim of this study was to obtain a 2005 snapshot of the New Zealand rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. A postal questionnaire was distributed to rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists in November 2005. The self-reported data included information on demographics, country of training, years in practice, business ownership, hours worked including on-call, and intention to leave rural practice.
Keywords: Personnel; Physicians; Rural health services; Nursing; Primary health care; Pharmacists
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Börner, H. E. (2008). Evaluating safe patient handling systems: Is there a better way? Ph.D. thesis, , .
Abstract: This observational study analyses the responses of 38 nurses from two similar units that use different patient handling systems to test the reliability and validity of the Safe Patient Handling Survey (TM) SPH Survey(TM), a perception survey and improvement tool for employees and employers. Currently there is a lack of tools for evaluating patient handling systems. The survey contains 55 questions divided into 6 clusters, staff and patient injury and violence questions, and picture questions depicting unsafe techniques. The data were analysed to see how the SPH Survey(TM) scores correlate with incidents, and its ability to detect differences between the two units. The results of the Pearson and Cronbach(TM) alpha tests show strong reliability, validity and consistency of the SPH Survey(TM). ANOVA comparison of means and Spearman(TM) rho tests shows that higher (better) scores on the SPH Survey(TM) clusters correlate with lower numbers of patient injuries, lower reports of verbal and physical violence episodes, and lower staff injuries. Differences were detected between the units with Unit 2 scoring higher than Unit 1 in all SPH Survey(TM) clusters and scoring lower in staff and patient injuries and violence incidents. Although the analysis was limited by the small sample size, the study has created a sound basis for further investigation. The SPH Survey(TM) is shown to be an easy way to reliably evaluate patient handling systems and workplace culture, target improvement initiatives, and continually monitor the level of patient handling risk in the workplace. Low-risk patient handling gives health care providers the means to focus on delivering high quality patient care, without endangering their own health and well-being.
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Fairhall, M. (2008). An observational study of Peripherally Inserted Central Cather(PICC)-related complications amongst oncology patients. Ph.D. thesis, , .
Abstract: This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days. Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer. These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate.
Keywords: Patient safety; Equipment and Supplies; Nursing specialties; Cancer; Oncology
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Murphy, S. E. E. (2008). Through mothers' eyes: The lived experience of caring for a child who has undergone and recovered from a liver transplantation. Ph.D. thesis, , .
Abstract: Mothers, whose children had undergone a liver transplant more than one year ago at time of interview and whose children were outpatients of Starship Children's Hospital, were invited to participate in this research. A Heideggerian hermeneutic phenomenological approach, informed by the work of van Manen (1990) was used. Three mothers of children who had received a liver transplant were interviewed to reveal the meanings of the phenomenon – what is the meaning of lived experience of mothers in caring for their child who has undergone and recovered following liver transplantation? Little previous study regarding mothers' lived experience of caring for their child, who had recovered from a liver transplant, was found in the literature. The emerging themes were punctuated with stress being a consistent feature. Utilising Ruddick's (1983) concepts of maternal thinking, the emerging themes were merged within the three interests governing maternal practice; preservation, growth and acceptability. The absolute capacity for attentive love draws the experience together. An essential theme identified out of the analysis was the concept of survival relating to the unique features of liver transplantation and the consequences of liver rejection and failure. The findings contribute to the understanding of the phenomenon, emphasising the need for good support systems for families of children who have undergone transplantation; assistance in the establishment of maternal coping strategies and regular feedback on the children's progress acknowledging the role and care provided by mothers.
Keywords: Parents and caregivers; Paediatric nursing; Children; Surgery
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Mockford, A. (2008). An exploratory descriptive study of the needs of parents after their young child is discharged from hospital following an admission with an acute illness. Ph.D. thesis, , .
Abstract: This study investigated issues surrounding the high numbers of preventable admissions of young children with acute illnesses, particularly amongst Maori and Pacific children. It focuses on what happens once these children are discharged. Its aims were to find out what the expressed needs of parents were, as they cared for their child, once home. Whilst there has been a small amount of international research undertaken in this area, there is little known about expressed parent need in the New Zealand context. This exploratory descriptive study involved parents of under five year old children, who had been admitted to a hospital, with one of five acute illnesses. Eighteen parents were surveyed over the telephone. This study found the parents expressed a need for reassurance and advice once home, and that they worried about their child getting sick again. It highlighted gaps in discharge planning and support. None of the parents had received a written discharge plan for their child. Only five parents had received either a contact number for advice or a referral back to their primary care provider. This study found that whilst some parents considered their discharge needs had been met, others considered that they had not. Four local discharge practice opportunities to support these families were recommended, these included, providing parents and caregivers with an individualised written discharge plan, giving a contact number for advice after discharge, offering a follow-up phone call in the first 48 hours, and ensuring that all children have a referral back to their primary health care provider. Areas for further research were highlighted, including the need for a larger study to explore and compare the needs of rural and urban parents, and Maori and Pacific parents.
Keywords: Parents and caregivers; Health knowledge; Children; Maori; Pacific peoples
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Campbell, K. (2008). Experiences of rural women who have cared for their terminally ill partners. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 166-178). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter firstly offers background information in relation to palliative care and the role of women as providers of care in the home setting. Secondly, it discusses a study that evolved from a trend the author observed as a district nurse providing community palliative care in rural New Zealand and from New Zealand literature; that the majority of carers of the terminally ill in home-settings are women. The aim of this research study was to offer insights into the requirements of caring for a dying person at home and provide information to assist nurses working in the community and other women who take on the caregiver's role.
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Sye, J. (2008). A fine balance. Ph.D. thesis, , .
Abstract: The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children's rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children's rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society's interest in children's rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children's health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children's health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children's rights whilst respecting the role of parents and families. The author argues that children's rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. She proposes that children's community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children's rights advocates.
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Hale, R. (2008). Older patient perceptions of transitional care. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 147-152). [Dunedin]: Rural Health Opportunities.
Abstract: The author describes transitional care as undertaken within the Waikato District Health Board health care environment. Transitional care supports people moving between acute health care (inpatient) and primary health care (home). It is a rehabilitative model based in smaller, predominantly rural communities to enable the older person to actively work towards recovery of functional ability within their own environment. Research indicates this rehabilitation model is applicable to the rural situation and satisfaction levels of the patients and caregivers tends to be positive.
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Brinkman, A. (2008). Collating for collaboration: Tertiary education funding structures. Wellington: New Zealand Nurses Organisation.
Abstract: The nursing education environment is complex and varied, and is affected by both the education and health systems. This report backgrounds the funding systems that underwrite the Tertiary Education Commission (TEC) processes. The two primary objectives that have guided this collation are: to stimulate awareness and discussion of the issues around funding nursing education in New Zealand; and to promote understanding of the complex funding structures currently in place in New Zealand by students, nurses, nurse educators and nurse managers.
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Hardcastle, J. (2008). 'Back to the bedside': Graduate level education in critical care. Nurse Education in Practice, 8(1), 46–53.
Abstract: This paper explores the relationships within teaching, learning and practice development in critical care nursing and questions the popular assumption that 'post graduate (Master's level) education fits all'. The need for critical care nurses to apply advanced knowledge and technical skills to complex and dynamic practice situations necessitates the development of critical thinking and a problem-solving approach to clinical practice that can be fostered through education and experience. Discussion focuses on the successful development and implementation of graduate level education for critical care nurses in the South Island of New Zealand and how this development is challenging existing approaches to the provision and evaluation of formal critical care education in New Zealand.
Keywords: Nursing specialties; Nursing; Education; Curriculum
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Tielemans, W. (2008). Encouraging young women to have regular smear tests. Kai Tiaki: Nursing New Zealand, 14(7), 16–18.
Abstract: The author presents the results of a study carried out as part of a research project with two nurse researchers from Maastricht University in the Netherlands. The aim of this study was to examine awareness among female students aged 18 to 25 about cervical cancer and to identify factors associated with their decision or intention to enter the cervical screening programme. Students aged 18-25 were recruited from four tertiary institutions in the Wellington region. A questionnaire was available online and distributed by student health centres and the researchers. Questions covered the following areas: intentions, attitude, knowledge, awareness, modelling, and support systems and efficacy. Data was analysed using descriptive statistics, multiple regression and independent t-tests. The findings are presented, and factors associated with intention and participation in cervical screening are discussed. The results indicate that the information concerning the national screening programme needs to be adjusted for the different age groups.
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Litchfield, M., & Jonsdottir, H. (2008). A practice discipline that's here and now. Advances in Nursing Science, 31(1), 79–92.
Abstract: The article is a collaborative writing venture drawing on research findings from New Zealand and Iceland to contribute to the international scholarship on the status and future direction of the nursing discipline. It takes an overview of the international historical trends in nursing knowledge development and proposes a framework for contemporary nursing research that accommodates the past efforts and paradigms of nurse scholars and reflects the changing thinking around the humanness of the health circumstance as the focus of the nursing discipline. It addresses contemporary challenges facing nurses as practitioners and researchers for advancement of practice and delivery of health services, and for influencing health policy.
Keywords: Nursing research; Policy; Nursing philosophy
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Walsh, K., Moss, C., Lawless, J., McKelvie, R., & Duncan, L. (2008). Puzzling practice: A strategy for working with clinical practice issues. International Journal of Law and Psychiatry, 14(2), 94–100.
Abstract: The authors share the evolution of innovative ways to explore, 'unpack' and re-frame clinical issues that exist in everyday practice. The elements of these processes, which they call 'puzzling practice', and the techniques associated with them, were delineated over a two year period by the authors using action theory based processes. The authors have evolved several different frameworks for 'puzzling practice' which they draw on and use in their practice development work and in research practice. This paper pays attention to a particular form of puzzling practice that they found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues. In this example 'puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle; exploring the heart of out practice; formulating the puzzle question; visualising the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored.
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Koorey, R. (2008). Is there a place for clinical supervision in perioperative nursing? Dissector, 35(4), 15–17.
Abstract: This article explores the concept of clinical supervision and outlines a brief history of implications for nursing practice. Models of clinical supervision are outlined and examples of how they may be applicable to the clinical setting of perioperative nursing are provided.
Keywords: Nursing models; Clinical supervision; Nursing specialties
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