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Arcus, K. J. (2004). Often wearisome, sometimes saddening, but always interesting: A hundred years of district nursing in Wellington, 1903-2003. Ph.D. thesis, , .
Abstract: October 2003 marked the centenary of Wellington district nursing. Annie Holgate, a 'trained, professional' nurse, was employed to care for the sick poor in 1903. The Wellington St John Ambulance District Nursing Guild funded district nursing for over fifty years. The first president, Sarah Ann Rhodes, left a legacy of a solid financial and administrative base for the whole of the Guild's existence. From 1945 the Wellington Hospital Board assumed responsibility for district nursing and expanded the service to the greater Wellington region. In 1974 the Community Health Services were formed, with Pauline MacInnes as the nurse leader. Expansion of healthcare in the community ensued, with district nurses pivotal to client-centred, community-based, collaborative healthcare. This service was dismantled in the wake of health sector restructuring in 1989. The philosophy and operation of the Community Health Service of this period bears a striking resemblance to the current concept of Primary Health Care. Primary sources from Wellington St John, Kai Tiaki and data from official publications were used to compile this history. Emergent themes are the autonomy of district nurses' practice, the invisibility of district nursing and the impact of visionary leadership. All have implications for the future of district nursing. District nursing, initially dependent on philanthropy, has been publicly funded in New Zealand since 1944. District nursing is now an essential component of health care.
Keywords: District nursing; History
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Uren, M. (2001). Nursing: A model for management: Why nurses are well equipped to be leaders of the future?.
Abstract: The subject of nursing leadership is approached by reviewing the literature of two prominent nursing theorists, Patricia Benner and Jean Watson, and the literature of transformational leadership. Common themes are identified. An exhortation is offered to nurses to consider that the caring characteristics of nurses are what is required in the corporate world of management. Chapter 1, questions whether nursing and management are different worlds or shared realities. It outlines the author's experience of practising as a manager in a complex organisation and the seeming barriers that exist between managers and nurses and management and nursing. A questioning of those barriers became the impetus for the review. Chapter 2, outlines the work of Patricia Benner and Jean Watson. Caring is identified as a core concept which is said to differ significantly from a conventional understanding of helping and is inextricably linked to a profound understanding of what it means to be human. Chapter 3, reviews the literature of contemporary managers who are exploring a transformed approach to leadership and management. Six themes are identified that are common to nursing theory and transformational leadership theory. Chapter 4, acknowledges that despite the similarities between nursing and contemporary management thought, there remains a gap between nurses and management. Rather than feeling optimistic about the future, and confident in assuming leadership roles, many nurses feel defeated and fearful about the future. It is suggested that this may be a consequence of bad experience of leadership, of loss of joy of caring and of failure to value the strength residing in the collective community of nurses. Nurses are encouraged to recognise that their knowledge and experience of caring and wholeness, healing, sharing and enabling, are the attributes that equip them to be leaders of the future health and corporate world.
Keywords: Nurse managers; Nursing; Leadership
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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, , .
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.
Keywords: Clinical decision making; Nursing
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Blanchard, D. L. (1995). Nursing practice in the changing health care environment “just keep going until you see it right”. Ph.D. thesis, , .
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Conroy, E. (2000). Nursing informatics in New Zealand: Evolving towards extinction? Ph.D. thesis, , .
Abstract: This project undertakes a critique and review of a decade (1990-2000) of available New Zealand literature to reveal the current state of nursing informatics utilisation in nursing practice. Since the early 1990s, nurses from diploma and baccalaureate nursing programs have been graduating with knowledge and skills in nursing informatics. Yet, when scrutinising the two main nursing publications for New Zealand, the author found scant publication of articles that pertain to this topic area of nursing. Competencies as product of the 1989 Guidelines for Teaching Nursing Informatics are a key consideration in this discussion, including ways in which the articles may reflect the content or intent of the Nursing Informatics curriculum as prescribed in these guidelines. This commentary discusses how nursing informatics has evolved in New Zealand nursing practice, situating its growth, or lack of, in the context of concurrent sociopolitical influences as well as conditions created by national and international nursing trends. Several recommendations are discussed to guide the future direction of nursing informatics for nursing education and practice in New Zealand.
Keywords: Informatics; Technology; Education; Nursing
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Boyle, S. D. (1994). Nursing education in New Zealand: a case study of experiential learning. Ph.D. thesis, , .
Abstract: This thesis presents a study of a nursing 'practicum' from the perspectives of nursing students and staff 'buddies'. A grounded theory approach was used to interview six nursing students during their transition placement, the final practicum of their Diploma in Nursing programme. Five staff nurse buddies selected by the students were also interviewed. An informal, conversational interview was used and data was analysed from an experiential learning perspective.This study differs from others because it focuses on the clinical experience component of nursing education, 'practicum', and includess practitioners viewpoints. At present there is a re-evaluing of experience within nursing education with a new emphasis on practice-based learning. Experience-based learning is becoming increasingly acceptable within academia as a 'seamless' education system evolves.I identified three learning stages which students' experience during practicum – initiation, exploration and consolidation. The key stage for learning through experience was exploration. Learning during this stage was predominantly buddy-directed which contradicted the self-directed curriculum design. Students and staff nurses however agreed that communication between them during this stage enabled the development of 'competence'.The learning /teaching approach used by the students and staff nurses made it difficult for students to translate their 'all-round' competencies during practicum. It is argued that it is the useof such competencies during practicum which enable nursing students to become autonomous in the attitudinal and epistemological sense. The predominantly 'technical training' approach adopted was understood by students and staff nurses to be reinforced by 'silence' from tutors.Restructuring gives the opportunity for nursing to develop an ';investigative', enquiry-based approach in practice. There will increasingly be an emphasis on practice-based research as a result of the implementation of degree and post-graduate programmes in nursing. This study highlights some aspects of nursing education and it's relationship with practice which can assist the development of such an approach
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McArtney, M. (2000). Nursing development units: Between a rock and a hard place. Ph.D. thesis, , .
Abstract: Practice development, situated at the nurse-patient interface, is a crucial aspect of professional development as a whole. The Nursing Development Unit (NDU) is one model of structured clinical practice development. NDU have their origin in a desire to provide the best possible care for patient through the support and development of autonomous therapeutic nurses. All possible sources of NDU-related literature from 1983-1999 were reviewed to determine the effectiveness of the NDU model. The purpose of the research was to establish the role of the parent organisation in supporting the ongoing viability of NDU; to describe the key processes and activities of NDU that are instrumental in the development of nursing practice; to clarify the role of the NDU in contributing to improved patient outcome; and finally to identify the critical indicator of successful NDUs for their application in the New Zealand context. The study found that British nursing journals have played a large part in promoting the NDU model. The pioneering units were given positive coverage and this has by and large continued. Accreditation systems have been important in maintaining standards and providing a generic framework for implementation. The trend is now towards internal funding from the parent organisation. The review identified a number of key features for the successful establishment of NDUs. NDUs appear to have under emphasised the development of socio-political acumen in the nursing staff. However, the NDU does offer a model for the development of confident, assertive, autonomous professionals. The NDU model values nursing as professional practice. The author concludes that the NDU model has stood the test of time, and demonstrated the ability to be at the vanguard of contemporary practice development. The model is flexible and its potential is maximised when it is tailored to meet the need of the parent organisation. The model has been successfully established in Australia, and has the potential to be adapted and refined for the New Zealand context.
Keywords: Professional development; Nursing
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Harker, D. Y. (2000). Nurses as patients: The stories of two woman nurse educators as recipients of nursing care. Ph.D. thesis, , .
Abstract: In this research two nurse-patients have engaged in a conversation about their experience of 'being nursed'. The project sets out to address the following questions: How might our experiences as nurses who have been hospitalised be drawn upon to influence positive changes in nursing practice? What effect might our experiences of hospitalisation have on us as nurses and on our nursing practice? The study utilises narrative as inquiry and the method of story telling and auto/biography to tell the stories of Maria (a pseudonym) and the researcher herself. This interpretive research has been informed by the feminist process and sits within a postmodern framework. Maria's stories were audio taped and transcribed before being prepared for analysis using 'core story creation', and the process of 'emplotment' (Emden, 1998b). The author's reflective topical autobiographical narrative was constructed through the processes described by Johnstone (1999). Three distinct qualities emerged from both experiences. The first, 'knowing as nurse-patient' contains the three sub-themes of 'having knowledge', 'expectations of being nursed', and 'knowledge gained'. The second distinct quality 'being nursed' contains the two sub-themes of 'feeling safe and cared for' and 'presencing'; and the third, 'not being nursed', contains the four sub themes 'feeling vulnerable', 'invisibility of nurses', 'getting out' and 'feeling let down'. The sub-theme 'getting out' includes three additional sub themes of 'wanting to get out and not wanting to be there', 'leaving and the need for closure' and 'not wanting to go back'. The author notes that nursing does make a difference to patient care. However, for patients to receive therapeutic care, new graduate nurses must be preceptored/mentored by experienced nurses in supportive programmes. Suggestions for further research have been identified.
Keywords: Nursing; Education; Preceptorship; Feminist critique
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Bryson, L. W. (2006). Nurse-led heart failure services: A review of the literature.
Abstract: This research paper reports on the findings of a literature review conducted to establish and analyse the international magnitude, context and effectiveness of nurse-led heart failure initiatives. The research revealed that the underlying philosophy in establishing nurse-led disease management programmes of care is that, by treating chronic heart failure as a continuum, it is possible to decrease exacerbations and improve patient outcomes. Regardless of the type of heart failure management programme, critical components of care include a collaborative supportive approach that educates and empowers the patient (including family/whanau) to recognise the early indicators of exacerbation, access expedient care, and to adhere to evidence based treatments. The author points to significant evidence to support the establishment of nurse-led heart failure programmes. The positive outcomes associated with this model of care delivery include decreased readmissions, reduction in mortality, and cost efficiencies. However, the organisational model of care, or programme components that are the most effective in optimising patient outcomes, need to be selected on the basis of local healthcare infrastructure, services and resources. The author suggests that New Zealand has a unique opportunity to encompass the recent emergence of the Nurse Practitioner role in facilitating, coordinating and monitoring of heart failure programmes across the continuum of care. The delivery of evidence-based, cost effective, heart failure programmes is a prerequisite to improving the delivery of optimal treatment and ensuring that heart failure patients have the opportunity to attain quality care outcomes.
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Raynel, S. (2002). Nurse-led clinics on ophthalmic practice: A vision for the future. Ph.D. thesis, , .
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Fitzpatrick, A. (1997). Nurse meeting another: cultural safety in nursing practice. Ph.D. thesis, , .
Abstract: This research project, a descriptive study using narratives, explored the application of cultural safety theory and philosophy to clinical nursing practice. This application was illustrated through the stories of four experienced Pakeha,Tauiwi registered nurses in Aotearoa/New Zealand, who described their realities of applying cultural safety to daily clinical practice. The incentive for this study had been identified in light of the current political climate, pragmatic realities and in keeping with the current state of knowledge.Cultural safety was first identified by Maori nursing students and subsequently described and articulated by Maori nurses, as being a potential solution to improving Maori health statistics in Aotearoa/New Zealand. Many Maori and Pakeha/Tauiwi in this country accept that the Treaty of Waitangi, a covenant signed between Maori and the Crown in 1840, is the incentive for giving cultural safety status and credibility. While the Nursing Council of New Zealand has supported this concept and made it a requirement for all nursing education, there is little literature written concerning its application to practice from a Pakeha/Tauiwi perspective.The perceptions and insights of these nurses were heard when they were invited to describe how they saw cultural safety as part of their daily clinical practice and recount their struggles, realities, practice and experience. The literature review supported the use of narratives as an appropriate method for this study. The philosophy and assumptions of narrative appear to match the oral tradition of nursing and thus it was considered possible to contemplate the fit of narrative to nursing research.The stories of these nurses, gave examples of best nursing practice in which cultural safety was integral to practice, and provided exemplars of possible beginnings and possible endings. The depiction of cultural safety in practice surfaced as the weaving of four themes which were consistent in all the stories – themes of reflection, reverencing, the environment, and hidden blessings and healing. The research evidence suggested that cultural safety was visible in practice in many diverse ways; it emphasised the complexity of the concept; accented its evolving status; and identified a relative consistency in defining cultural safety despite the varied contexts of practice.Although this study was limited by the small sample, the findings indicated that there were potential implications for nursing education, research, nurses and nursing practice as well as for other health care providers working in the current health care system. They suggested that actions from nurse educators, nurse managers, health care managers and clinical nurses themselves, would be needed to ensure that cultural safety continued to be part of nursing practice and contribute to the improvement of all health statistics in this country as well as to encourage an increased development in the focus on Maori health issues.Further nursing research suggested by the findings include studies to appraise cultural safety from a patient's perspective, and consideration given to the evaluation and assessment of nurses and their culturally safe practice. In addition, exploration and research could ascertain the benefits and rewards of culturally safe practice and identify ongoing educational needs as well as examining the views of other members of the multi-discipline team
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Woodward, J. (1999). Nurse case management: A review of the literature. Ph.D. thesis, , .
Abstract: This literature review is an exploration of nurse case management and it will provide the background for the introduction of a nursing case management model in the acute surgical environment at Western Bay Health. Case management is a collaborative process which assesses, plans, implements, co-ordinates, monitors and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes (Newell, 1996:.3). In undertaking this review it was the author's intention to include the findings as background to a business case seeking the introduction of a surgical nurse case management model within the surgical service.
Keywords: Nursing; Nursing specialties; Surgery; Care plans
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Street, A., & Walsh, C. (1995). Not just a rubber stamp! mental health nurses as Duly Authorised Officers (Vol. 10). Ph.D. thesis, , .
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Meldrum, L. B. B. (2006). Navigating the final journey: Dying in residential aged care in Aotearoa New Zealand.
Abstract: New Zealand statistics project that the aging population of people aged 65 years and over will more than double in the next decade. This has implications for palliative care providers including hospices and hospitals because long-term inpatient care is not generally provided by hospitals and hospices. When dying patients need long-term care, residential settings become an option. The level of palliative care in these facilities is dependent on staff training and numbers. In general, staff are not trained in palliative care, neither do they provide the multidisciplinary facets that define palliative care as undertaken by hospices. This paper describes a practice development initiative using storytelling as the vehicle for introducing the concept of the Liverpool Care Pathway (LCP) for the dying patient into residential aged care settings. With the emergence of a reflective paradigm in nursing the concept of storytelling as a teaching/learning tool has grown. Many staff in residential care settings come from diverse ethnic backgrounds where for some, English is their second language. Storytelling therefore can be a useful approach for learning because it can increase their communication skills. The author suggests that the Liverpool Care Pathway for the dying patient is a model that can be translated across care settings, hospice, hospital, and community. It can demonstrate a framework that facilitates multiprofessional communication and documentation and embraces local needs, culture and language to empower health care workers to deliver high quality care to dying patients and their family/whanau and carers. This paper also explores the role of a facilitator as an agent of change and discusses how the interplay of evidence, context and facilitation can result in the successful implementation of the LCP into residential aged care settings.
Keywords: Palliative care; Older people; Rest homes
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Clark, R. R. (1998). My fat arm: Living with lymphoedema following treatment for breast cancer. Ph.D. thesis, , .
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