Carter, H., McKinlay, E. M., Scott, I., Wise, D., & MacLeod, R. (2002). Impact of a hospital palliative care service: Perspective of the hospital staff. JBI Reports, 18(3), 160–167.
Abstract: The first New Zealand hospital palliative care support service was established in 1985. Different service models have now been adopted by various major hospitals. In 1998, a palliative care service, funded by Mary Potter Hospice, was piloted at Wellington Public Hospital. Twelve months post-implementation, the hospital staff's views of the service were evaluated. It was found that referrals to palliative care from hospital specialities outside the Cancer Centre increased. While most doctors, nurses and social workers strongly agreed or agreed that the service positively influenced patients' care and effectively addressed their symptom management needs, spiritual needs were less often met. Over 90 percent of each discipline strongly agreed or agreed that the service had assisted them in caring for patients, but, only about a half agreed that useful discharge planning advice and staff support was provided. Significant differences in responses were found between different disciplines and specialities. One fifth of the staff identified palliative care education needs. Recommendations are made concerning the development of a future hospital palliative care service.
|
Sheward, K. A. (2005). Exploring the juxtaposition of end of life care in the acute setting and the integrated care pathway for the care of the dying.
Abstract: The primary aim of this research paper is to draw on the literature to offer some insight into end of life care in the acute hospital setting. The secondary purpose is to provide an understanding of the integrated clinical pathway (ICP) for the care of the dying, consider its influence related to some of the challenges shaping end of life care and the positive effect it can generate on the quality of care experienced. There are significant challenges that impact on both the delivery and receipt of care for dying patients and their families. Six key influential barriers are considered within the context of the acute setting. Communication and the acute environment are two areas that significantly impact on the quality of care delivered, and are explored in more depth. Narratives from nursing and medical staff convey the realities encountered and difficulties experienced when they are unable to provide the care to which they aspire. Stories are shared by patients and families, which reflect on their experience of end of life care in the acute setting, and offer heath professionals some insight into the lives of the people nurses care for. The literature in relation to the development and implementation of the Liverpool Care of the Dying Pathway, and an overview of the Pathway document is presented. The strengths and limitations of its use are considered, alongside its influence beyond the documentation of clinical care. It is not possible to transfer the hospice service into the hospital setting, however the author suggests that through the implementation of the clinical pathway there is an opportunity to transfer best practice guidelines and positively influence the palliative culture in the acute setting.
|
Malcolm, H. (2004). Patient privacy in a shared hospital room: Right or luxury? Nursing Praxis in New Zealand, 20(1), 28–35.
Abstract: In this article the author discusses the New Zealand legislation aimed at protecting the individual's right to privacy and concludes that practice may place healthcare consumers' rights at risk. While patient privacy should be of concern to all health professionals, the focus here is on the nurse's role in relation to recently formulated competencies published by the Nursing Council of New Zealand, which includes the recommendation that care be seen to exhibit an awareness of healthcare consumers' rights to privacy alongside the expectation that nurses question practices that compromise patient privacy.
|
Beaver, P. J. (2015). Contemporary patient safety and the challenges for New Zealand. Ph.D. thesis, University of Auckland, .
Abstract: Outlines the history, emergence, necessity, challenges, and strategies of the patient safety movement. Explores the challenges for staff working to reduce harm and implement safety improvement in NZ hospitals. Considers medical harm as a persistent and expensive threat to public health. Analyses health policy in the US, England and NZ using the theory of countervailing powers, and a shift from medical to managerial dominance. Reviews theories of accidents and risk, and the safety improvement literature. Provides staff perspectives from NZ by means of interviews with doctors, nurses and managers in two hospitals.
|
McCloskey, B. A., & Diers, D. (2005). Effects of New Zealand's health reengineering on nursing and patient outcomes. Medical Care, 43(11), 1140–1146.
Abstract: This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care.
|
Becker, F. (2005). Recruitment & retention: Magnet hospitals. Ph.D. thesis, , .
Abstract: International nursing literature indicates nursing shortages are widely recognised; however efforts to remedy poor recruitment and retention of nurses have been largely unsuccessful. This paper presents the predominant factors influencing poor recruitment and retention of nurses, such as: the image of nursing as a career, pay and conditions of employment, educational opportunities, management and decision making, and low morale and then explores how Magnet hospitals address these factors. During the 1980s, several hospitals in the United States were identified as being able to attract nursing staff when others could not, they became known as 'Magnet' hospitals. The American Nurse Credentialing Centre developed the Magnet Recognition programme to accredit hospitals that meet comprehensive criteria to support and develop excellence in nursing services. Magnet hospitals not only attract and retain satisfied nursing staff, but also have improved patient outcomes compared to non-Magnet hospitals, such as decreased patient morbidity and mortality and increased patient satisfaction. The successes of the Magnet Recognition programme in recruitment and retention of nurses is discussed in relation to its transferability outside of the United States, particularly to New Zealand as a way of improving recruitment and retention of nurses here.
|
Carryer, J. B., Budge, C., & Russell, A. (2002). Measuring perceptions of the Clinical Career Pathway in a New Zealand hospital. Nursing Praxis in New Zealand, 18(3), 18–29.
Abstract: The authors outline the Clinical Career Pathways (CCPs) for nurses, which were first established in New Zealand during the late 1980s. This paper introduces a new instrument, the Clinical Career Pathway Evaluation Tool (CCPET) designed to assess nurses' and midwives' knowledge of and attitudes towards their Clinical Career Pathway. The 51 item instrument takes the form of a self-report questionnaire. The development of the CCPET is described and results from an initial application of the instrument with 239 nurses and midwives in a New Zealand hospital are presented. Results indicate that knowledge levels were moderate in this sample and were correlated with both positive and negative attitudes. Results of t-test comparisons indicated that, on average, the group who had already completed a CCP portfolio had greater knowledge and more positive attitudes than the group who had not.
|
Walsh, K., McAllister, M., Morgan, A., & Thornhill, J. (2004). Motivating change: Using motivational interviewing in practice development. Practice Development in Health Care, 3(2), 92–100.
Abstract: The present paper draws on experiences and insights gained by a group of psychiatric nurse practice development facilitators whilst working with consumers, carers, clinicians and managers in the context of a practice development programme in a large metropolitan psychiatric hospital. The paper describes how the practice development facilitators were able to adapt techniques of motivational interviewing, commonly used in drug and alcohol treatment services, to help motivate change in an aged care setting. The lessons embedded within this experience are that people do want change, and that sustained change requires ownership and support. Practice development facilitators can assist in this process though the use of principles and strategies of motivational interviewing, which include increasing awareness of the need for change, supporting self-efficacy and managing resistance to change.
|
O'Malley, J. (2001). Critical social analysis of acute institutionally based mental health nursing following an action research project. Ph.D. thesis, , .
Abstract: This study using action research involving twelve registered nurses worked toward improving nursing care in an acute mental health in-patient service. Following focus groups with consumers, families, nurses, doctors, and allied health professionals, the action research group developed projects over eighteen months to improve continuity and consistency of nursing care. There was a subsequent restructuring of nursing service to better define leadership, accountability and to strengthen care delivery. The second half of the thesis involves a critical social analysis of the research data and produces a theory of mental health nursing which, the author suggests, has wide application in practice.
|
Mosley, B. (2005). Seclusion management in an acute in-patient unit. Ph.D. thesis, , .
Abstract: This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. It also includes the author's personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses' way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person's level of acuity and to their ability to engage in this approach in a tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.
|
|
Walsh, C., Boyd, L., Baker, P., Gavriel, A., McClusky, N., Puckey, T. C., et al. (2001). It was time for me to leave: A participatory action research study into discharge planning from an acute mental health setting. Wellington: Victoria University of Wellington.
|
Vermeulen, J. (2002). “And there's the likes of me”: A phenomenological study of the experience of four women inpatients at a mental health unit. Ph.D. thesis, , .
Abstract: This research draws on the experiences of four women whilst they were inpatients at the Mental Health Unit in Southland. The Husserlian path of phenomenology was followed and in-depth interviewing used to collect data. Colaizzi's method of analysis enabled accurate interpretation of transcripts. The overall goal of this research was to provide health professionals with an opportunity to inform their practice, based on what consumers were saying about their experience of hospitalisation. Themes emerged through participants relating their experience by using comparisons with either their outside world or previous episodes of hospitalisation. Through analysis, two fundamental structures became evident within the findings. These were 'the environment as containment' and 'the road to recovery'. The author concludes that this study raises significant issues surrounding the experience of hospitalisation at the Mental Health Unit that have implications for future research and for future service delivery.
|
Crogan, P. A. (2010). Nurses' perceptions of their role in quality improvement change. Master's thesis, University of Auckland, Auckland.
Abstract: Explores how nurses perceive quality improvement (QI) change, determines what is needed for nursing to further contribute to QI change and identifies the potential disconnect between the two. Undertakes a sequential, mixed-methods approach, using a questionnaire followed by a focus group representing 10 per cent of RNs at Middlemore Hospital.
|
Finlayson, M., & Gower, S. E. (2002). Hospital restructuring: Identifying the impact on patients and nurses. Nursing Praxis in New Zealand, 18(2), 27–35.
Abstract: The authors report a survey of all nurses working in hospitals included in the International Hospital Outcomes Study of staffing and patient outcomes in New Zealand's secondary and tertiary hospitals from 1988-2001. The survey examines the way in which the hospitals have been restructured and analyses patient outcomes. Research has identified links between how nursing is organised in a hospital and that hospital's patient outcomes.
|
|
McDonald, S. (2000). A study to investigate the role of the registered nurse in an acute mental health inpatient setting in New Zealand: Perceptions versus reality. [Manukau City]: Manukau Institute of Technology.
|
