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Holbrook, P. (2005). Nurse initiated analgesia in an emergency department: Can nurses safely decrease door to analgesia times by providing analgesia before medical assessment? Ph.D. thesis, , .
Abstract: Pain management practices within emergency departments require a more patient focused approach due to extended waiting times for analgesia. This dissertation questions current methods of providing timely and appropriate delivery of analgesia. Nurses represent the biggest resource in emergency departments therefore are in a position to be able to access patients in a timely fashion. A review of the literature pertaining to nurse initiated analgesia protocols has been evaluated and information relating to efficiency and safety utilised to discuss the processes for planning and implementation of a similar protocol. The author finds that the literature provides no evidence that nurse initiated analgesic practices prior to medical assessment compromises patient safety or delays diagnosis. A discussion of the benefits to patients, nurses and the institution has been included to highlight the appropriateness of extending nursing roles.
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Bleach, A. (2005). Nurses talk the walk: An exploration of nurses' perception of advanced nursing practice on acute mental health inpatient units in New Zealand. Ph.D. thesis, , .
Abstract: The last twenty years, particularly the early 1990s, ushered in major mental health sector reforms inclusive of deinstitutionalisation policies and subsequent development of community services. Concurrent changes to student nurses' education left registered nurses as the workforce mainstay on inpatient units. However, the author suggests, an emerging global shortage of nurses and implementation of the Employment Contracts Act (1991) negatively impacted on recruitment and retention of registered nurses. Inpatient nurses either left nursing or moved to community positions for better money and increased job status. The author suggests that, as a consequence, the 'critical mass' of experienced and skilled nurses who traditionally provided nursing leadership disappeared resulting in compromised standards of care for patients. As the manager of an inpatient unit, the author proposed the establishment of advanced nursing practice roles as one initiative to provide nursing leadership in order to attract and retain nurses. This study explored five inpatient nurses' perceptions of advanced practice and whether these roles could assist to provide leadership and improve standards of care. The research was a qualitative exploratory descriptive study using a focus group interview as the data collection method. A thematic analysis of the group discussion transcription revealed three key themes: 1) the 'makeup' of advanced nursing practice, 2) moving forwards: establishing roles, 3) moving sideways: barriers to role development. The themes are critically discussed in relation to selected literature. The thesis includes recommendations that could be used by nurses responsible for planning and implementing advanced practice roles on inpatient units.
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Topliss, J. (2005). Nursing by telephone in mental health emergency settings: What underpins and informs clinical practice?.
Abstract: This dissertation is an exploration of what underpins and informs clinical nursing practice by telephone in mental health emergency settings. A critical review of the literature provides the foundation for discussion. Points of reflection explore links between the literature and the author's own experience and thoughts about clinical practice. Findings are presented within three main sections. 'Historical Context' considers the development and function of mental health emergency service telephone work. Practical aspects are discussed under `Service Provision Context.' 'Nursing Context' explores the fundamental skills involved in clinical reasoning and the preparation of staff for telephone work. Whilst 'Best practice' in the area of nursing by telephone is yet to be well defined, this work aims to provide a foundation for further inquiry, research and dialogue.
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Lake, S. E. (2005). Nursing prioritisation of the patient need for care: Tacit knowledge of clinical decision making in nursing. Ph.D. thesis, , . Retrieved July 7, 2024, from http://hdl.handle.net/10063/22
Abstract: Effective nursing prioritisation of the patient need for care is integral to daily nursing practice but there is no formal acknowledgement or study of this concept. Utilising the retroductive research strategy of critical realism, this thesis explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. The tacit knowledge discerned within the literature indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Such nursing prioritisation takes place concurrently between the competing or even conflicting needs of the several individual patient presentations within the nurse's caseload. Varied frames of reference within different practice settings create specific imperatives on this dynamic and non-sequential process. Starting with an initial set of studies in the 1960s, study of clinical decision-making in nursing has created a significant body of knowledge encompassing a range of approaches. Nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain language descriptions of nurse decision-making. Within the selected literature it is apparent that nursing prioritisation of the patient need for care is an advanced skill of nursing that is developed in practice and honed through experiential learning.
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McNab, M. (2005). The nursing roles in respect of tuberculosis in New Zealand from 1928 to 1966. Ph.D. thesis, , .
Abstract: In this thesis the nursing roles in respect of tuberculosis in New Zealand from 1928 to 1966 are identified, and then examined by contextualising them in relation to the changing social, political, demographic, scientific and technological environments in which the treatment and prevention of tuberculosis took place. The history of the various institutions is described in order to show some of the circumstances that led to the evolution of the roles of dispensary nurse, district nurse, school nurse, public health nurse, sanatorium nurse, and hospital nurse. 1928 to 1966 covers a sufficiently long period of intensive activity and change in the detection, treatment and research of pulmonary tuberculosis in New Zealand, to enable comparisons between nursing roles to be made. It was found that nurses had an individualised approach to their work. This was defined by the physical environments within which they worked, whether it was a hospital, sanatorium, dispensary, school or in a patient's home. Also, the medical treatments advocated and implemented by the medical practitioners, the rules and regulations which governed the various work areas, and the availability of staff, funds, facilities and resources all had an impact upon how nurses were able to work and how their respective roles developed. In addition, some of the factors which contributed to nurses getting tuberculosis and the initiatives to improve the nurse's conditions of work are examined, because these had an impact on the performance of the nurse's work and evolution of her role. Apart from practical nursing care, nurses also had a role in the on-going inspection, monitoring, notification, emotional support of patients and families, morale boosting and education. Each role had these components. The differences were in the time and emphasis given to each.
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Fitzwater, A. (2005). The impact of tourism on a rural nursing practice. Ph.D. thesis, , .
Abstract: Rural nursing in the remote context of South Westland is shaped by factors common to rural nursing practice world-wide including geographical and professional isolation, living and working in a small community, providing health care to rural people and the broad, generalist and advanced scope of nursing practice. Tourism is a major industry in the townships in the proximity of the two accessible glaciers in South Westland. The practice of the nurses in these areas is significantly affected by tourists seeking health care and by providing a health service for the large number of migrant seasonal workers who service the tourist industry. Tourists seek health care from the nurses across the full spectrum of health problems and their expectations of the health care required may exceed the service that can be provided. The nurses are challenged to advance their practice to find the personal and professional resources to provide a safe service. This includes the challenge of cultural safety and personal safety. The tourist industry brings significant numbers of young people as seasonal/temporary workers to the glacier areas. This imposes a youth culture onto the existing rural culture. Nursing practice has expanded to include the specialist practice of youth health care that includes the problems of alcohol and drug misuse, sexual and reproductive health, and youth mental health. This work is drawn from the experience of the nurses working in the glacier communities. The impact of the tourism industry on their rural nursing practice includes the increasing volume of work that challenges the viability of the service, the advanced scope of practice required to meet the health needs of tourists and the seasonal tourist industry workers, and challenges to personal and professional safety.
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Alavi, C. (2005). Breaking-in bodies: Teaching, nursing, initiations or what's love got to do with it? Contemporary Nurse, 18(3), 292–299.
Abstract: This paper discusses how students become able to work with sick patients for whom they may feel disgust or discomfort. It is a sustained engagement with the literature on abjection and disgust and is not the outcome of evaluation research. It considers the role of problem-based learning pedagogy in facilitating students' negotiation of their own discomfort and horror, and describes experiences which enable them to approach abject patients with more comfort and less disgust. The paper argues the importance of creating spaces where students can explore issues which are distressing and disturbing so that they will feel able to remain in nursing.
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Bland, M. F. (2007). Betwixt and between: A critical ethnography of comfort in New Zealand residential aged care. Journal of Clinical Nursing, 16(5), 937–944.
Abstract: This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents' comfort. A critical ethnographic approach was used and fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination. Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be 'betwixt and between' comfort and discomfort simultaneously. The constraints of one-size-fits-all care delivery practices and the tensions inherent in communal living compounded residents' discomfort. The findings show that individualised care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents.
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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.
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Teekman, B., & Stillwell, Y. (2000). Exploring reflective thinking in nursing practice. Journal of Advanced Nursing, 31(5), 1125–1135.
Abstract: Sense-Making, a qualitative research method, was used to obtain and analyse data from interviews with 10 registered nurses, in order to study reflective thinking in actual nursing practice. Ten non-routine nursing situations were analysed for the presence of reflective thinking. Reflective thinking was extensively manifest, especially in moments of doubt and perplexity, and consisted of such cognitive activities as comparing and contrasting phenomena, recognising patterns, categorising perceptions, framing, and self-questioning in order to create meaning and understanding. Self-questioning was identified as a significant process within reflective thinking. By exploring and analysing the type of questions respondents were asking themselves, the study uncovered three hierarchical levels of reflective thinking, focussed on action, evaluation and critical enquiry. The findings of this study resulted in the development of a model of reflective thinking, which is discussed in terms of the implications for learning in nursing practice.
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Kaviani, N., & Stillwell, Y. (2000). An evaluative study of clinical preceptorship. Nurse Education Today, 20(3), 218–226.
Abstract: A preceptorship programme of 100 hours duration was developed and delivered by a nurse education institute, in consultation with a health care organisation. The purpose of the study was to examine preceptors, preceptees, and nurse managers' preceptions of the preceptor role and factors which influenced the performance of preceptors. Using focus groups, participants were each asked to identify the outcomes of the programme in practice. Study findings highlighted the importance of formal preceptor preparation, personal and professional development of the preceptors, and the promotion of positive partnerships between nurse educators and nurse practitioners. The need for formal recognition of the preceptor role in practice, particularly in relation to the provision of adequate time and resources, emerged from the study. The research findings enabled the development of an evaluative model of preceptorship, which highlights the intrinsic and extrinsic factors impacting on the preceptor role
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Gallagher, P. (2000). An evaluation of a standards based portfolio [Corrected and republished article printed in NURSE EDUC TODAY 2001 Apr; 21(3): 197-200]. Nurse Education Today, 20(3), 218–226.
Abstract: This study is an evaluation of student perceptions of a standards based portfolio, which is a is a series of student work that seeks to address pre-determined learning outcomes. Of interest to the study was the relationship between theory and practice, the availability of resources to complete the assignment and the contribution the portfolio made to the process of learning. For a particular unit of learning, 'Nursing Business', second year undergraduate students in the Bachelor of Nursing programme were required to complete a portfolio. The assessment directed the students to meet specific criteria which in turn reflected the learning outcomes.
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Cowan, L. M., Deering, D., Crowe, M., Sellman, D., Futterman-Collier, A., & Adamson, S. (2003). Alcohol and drug treatment for women: Clinicians' beliefs and practice. International Journal of Mental Health Nursing, 12(1), 48–55.
Abstract: The present paper reports on the results of a telephone survey of 217 alcohol and drug treatment clinicians on their beliefs and practice, in relation to service provision for women. Nurses comprised the second largest professional group surveyed. Seventy-eight percent of clinicians believed that women's treatment needs differed from men's and 74% reported a range of approaches and interventions, such as assisting with parenting issues and referral to women-only programmes. Several differences emerged in relation to approaches and interventions used, depending on clinician gender, work setting and proportion of women on clinicians' caseload. Implications for mental health nursing include the need to more systematically incorporate gender-based treatment needs into practice and undergraduate and postgraduate education and training programmes.
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Farrow, T., McKenna, B., & O'Brien, A. J. (2002). Advanced 'prescribing' of nurses' emergency holding powers under New Zealand mental health legislation. International Journal of Mental Health Nursing, 11(3), 164–169.
Abstract: A new approach to mental health legislation has seen the involvement of a range of health professionals in legislated mental health roles, including the power of registered nurses to detain patients in hospital under Section 111 of the New Zealand Mental Health (Compulsory Assessment and Treatment) Act (1992). Under this Section, a nurse who believes that a voluntary patient meets the legal criteria of the Act can independently detain the patient for a period of up to six hours, pending further assessment by a medical practitioner. However, anecdotal evidence and a clinical audit undertaken by the authors suggest some doctors 'prescribe' Section 111 at the time of admission. This practice instructs nurses to initiate Section 111 if particular voluntary patients choose to leave hospital. This study outlines practice issues resulting from 'prescribing' Section 111; provides a legal critique of medical practitioners' involvement in this practice; and makes recommendations for guidelines toward a more constructive use of Section 111.
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Giddings, D. L. S., & Grant, B. M. (2007). A Trojan Horse for positivism? A critique of mixed methods research. Advances in Nursing Science, 30(1), 52–60.
Abstract: This paper presents an analysis of mixed methods research, which the authors suggest is captured by a pragmatically inflected form of post-positivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favour the forms of analysis and truth finding associated with positivism. The authors anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, they recognise that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.
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