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King, S. L. J., & Walsh, K. (2007). 'I think PCA is great, but . . .'- Surgical nurses' perceptions of patient-controlled analgesia. International Journal of Nursing Practice, 13(5), 276–283.
Abstract: This qualitative study investigated surgical nurses' perceptions of patient-controlled analgesia as a strategy for managing acute pain in a tertiary care hospital. Patient-controlled analgesia is commonly used and nurses play an essential role in caring for patients prescribed it. The study was divided into two parts. First, audiotaped semi-structured interviews were conducted with 10 nurses. The interviews were followed by a postal questionnaire to 336 nurses with 171 returned. Thematic analysis was the chosen methodology. The audiotaped transcripts and questionnaires surfaced five themes, with the dominant one being `I think PCA is great, but . . .'. The paper outlines and explores these themes and addresses the implications arising from the research for both clinical practice and education.
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Macfie, B. (2006). Assessing health needs and identifying risk factors. Kai Tiaki: Nursing New Zealand, 12(6), 16–18.
Abstract: In 2004, Plunket nurses from eight areas around New Zealand participated in collecting data for a research project on health needs assessment practices. This project aimed to examine risk factors identified by Plunket nurses, what areas of health need considered to be priorities; grading of health needs; and how closely the results of health need assessment aligned with the individual clients' deprivation score. The researchers examine the assessment of health needs against the use of the Deprivation Index, which indicates a specific population in a specific area, as a funding model. This study appeared to show there are two distinct groups of clients assessed as high needs: those with risk factors such as family violence and severe parental mental illness, and who may live in an area of 1-7 deprivation; and those with multiple risk factors which include poverty, low education, and/or reluctance to access services and support, and who usually live in dep 8-10 areas. This research supports the anecdotal evidence that significant health needs exist outside the lower deprivation areas.
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Challis-Morrison, S. (2006). Caring for a community wanderer. Kai Tiaki: Nursing New Zealand, 12(11), 20–22.
Abstract: A community based registered nurse from Waikato District Health Board's Older Persons Assessment Team (OPAT) presents her experiences of working with older people with dementia. She uses a case study approach to highlight the issue of wandering, behaviour which can be difficult to modify and can cause carer distress. She outlines a team approach to the condition which requires good communication and co-ordination. Key aspects of management included a risk assessment plan, support for caregivers, and encouraging activity.
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Dellagiacoma, T. (2007). Contracting as a career option for nurses. Kai Tiaki: Nursing New Zealand, 13(1), 20–22.
Abstract: A nurse presents research and her own experiences of contracting. Contracting, as defined in this article, refers to a nurse not employed permanently on a wage. It covers agency nursing, short and long fixed-term contracts and secondments. The author identifies the need to continue to develop professionally, which is now a mandatory requirement under the Health Practitioners Competence Assurance (HPCA) Act. Contractors have little, if any financial support to develop professionally, and time taken to do courses is not paid. Taking study leave within a contract may also not be an option. Options for managing professional development in these conditions are offered, including goal setting, investing in education or training, and considering some longer contracts. Practical financial advice and examples are given, including managing accounts and consideration of employment law. The author recommends that skilled nurses looking for interesting ways to develop their careers and to branch out in an entrepreneurial way should seriously consider taking up contract work.
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Richardson, S. (2005). Coping with outbreaks of the norovirus. Kai Tiaki: Nursing New Zealand, 11(7).
Abstract: The author presents an overview of the impact and management of novovirus infections in New Zealand. The impact of this highly contagious virus on hospital settings is serious. With staff shortages already a problem, any outbreak of contagious disease has the potential to result in unsafe staffing, either through low numbers or poor skill mix. A report from New Zealand Environmental Science and Research (ESR) showed 35 reported norovirus outbreaks in New Zealand in the first quarter of 2004, resulting in 890 cases of the disease. Norovirus outbreaks are characterised by a rapid spread of infection, high uptake rate, and a high proportion of cases presenting with projectile vomiting. The author provides a definition of the novovirus, and looks at transmission, the management of hospital outbreaks, and the impact on emergency departments and hospital wards. Procedures include in-patient isolation. She notes there are no simple answers or “quick fixes” to the problem of norovirus outbreaks. While ongoing surveillance, recognition and isolation are key elements, there are wider structural and political implications that need to be acknowledged. These issues include overcrowding and staff shortages.
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Neville, S. J., & Gilmour, J. A. (2007). Differentiating between delirium and dementia. Kai Tiaki: Nursing New Zealand, 13(9), 22–25.
Abstract: Accurate nursing assessment is a critical element in the identification of health problems and treatment strategies for older adults who have delirium and/or dementia. This practice update provides information on the differentiation between these two debilitating and adverse health events, along with some useful assessment frameworks and other resources. Comments from people with delirium and dementia are interspersed throughout the article to draw attention to the impact of these conditions on people's lives and well-being. The article includes the 'A presenting concern framework', useful mnemonic devices to help nurses assess an older person who may have delirium or dementia, and a list of online resources.
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Hunt, M. (2006). Nurses can enhance the pre-operative assessment process. Kai Tiaki: Nursing New Zealand, 12(10), 20–22.
Abstract: This reports on an initiative at Whakatane Hospital, where a Nurse-Led pre-assessment (NLPA) was delivered at an outpatients clinic. NLPA involves taking a comprehensive medical history, a nursing assessment, physical examination, airway assessment, ordering appropriate investigations and carefully documenting the process and results. More valuably, it provides an opportunity for the patient to participate in planning their care. The aim of this initative was to short circuit delays and congestion in existing pre-assessment clinics, streamline the pre-assessment process and reduce the number of patient visits to hospital. Reducing cancellations of surgery (often on the day of surgery) and “did not appear” (DNA) numbers were also objectives. After a small pilot, a six-month trial was funded by the Ministry of Health. Over the six-month trial, 373 patients attended NLPA; 178 patients required anaesthetist review before surgery, and 198 could proceed directly to surgery following NLPA. An anonymous postal survey was made of patients, who indicated satisfaction with the service. Other outcomes are discussed, and the trial was deemed successful. Follow up plans have been disrupted by restructuring at the hospital and the clinic has yet to be implemented.
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McKenna, B., O'Brien, A. J., Dal Din, A., & Them, K. (2006). Responsible clinician role offers opportunities for nurses. Kai Tiaki: Nursing New Zealand, 12(11), 12–14.
Abstract: The authors report on a recent study investigating the statutory role of responsible clinician. Statutory roles under mental health legislation offer mental health nurses a means of having advanced practice skills recognised, as well as contributing to improved access to services. There is a proliferation of roles intended to develop nursing readership, but in most cases they are not primarily clinical roles. The concept of “advanced practice” has become a means of developing clinical leadership roles in nursing. Research on responsible clinician role is presented along with the results of a survey of the 11 Registered Nurses practicing as responsible clinicians, five senior nurses from each of the 21 district health boards, and the Auckland Regional Forensic Psychiatry Services (n = 121). Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain or maintain that role. They were also asked which competencies for the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. A clear majority of the respondents felt the role of the responsible clinician was a legitimate advanced practice role for mental health nurses. Despite this, some respondents expressed ambivalence about taking on the role. The research highlighted deficits in knowledge and skills that could become a focus of education for advanced practitioners seeking appointment as responsible clinicians. Deficits included some assessment skills, knowledge of a range of interventions and knowledge of other legislation affecting mental health legislation.
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Flint, V. (2005). The place of ECT in mental health care.11(9), 18–20.
Abstract: The author reviews the controversial treatment of electroconvulsive therapy (ECT) which has re-emerged as a safe and effective treatment for major depressive disorders. She first addresses the popular conceptions of ECT, which are based on early misuse of the treatment when it was delivered unmodified, or forcefully and without anaesthetic. She then uses a case study to illustrate the benefits of ECT for catatonia and catatonic states. Diagnostic criteria for catatonia include motoric immobility, excessive motor activity, extreme negativism or mutism, peculiarities of voluntary movement, and echolalia or echopraxia. The treatment of a patient is detailed, and the role of the ECT nurse is outlined. The ECT nurse is a co-ordinator, an educator, liaises with other services and families, and is a point of contact about ECT within the mental health service generally and in the ECT unit in particular. The case study showed successful use of ECT. A series of eight ECT treatments were administered to the catatonic patient, after which he was discharged home with minor depression and showing signs of enjoying life once again.
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Gregory, R., & Kaplan, L. (2008). Understanding residuals in Guillain-Barre Syndrome. Kai Tiaki: Nursing New Zealand, 10(7), 16–18.
Abstract: The authors review the literature on the residual effects of Guillain-Barre Syndrome (GBS), which can include fatigue, foot drop or numbness, reduced mobility and nerve tingling. In GBS the peripheral nerves are attacked by the body's defence system, an auto-immune attack, and as a result, the myelin sheath and axons of nerves are impaired. The pathophysiology of the illness and long term effects are presented, and implications for nursing care and rehabilitation are discussed. Two case studies are included which illustrate coping with the long-term effects of GBS, the effect of GBS residuals on extreme fatigue and depression.
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Lewer, D. (1999). Analysing the Mental Health Act. Kai Tiaki: Nursing New Zealand, 5(8), 14–16.
Abstract: Changes brought by the Mental Health Act (MHA) to clinical practice, and some of the problems it has created for nurses, are examined in this article. Compulsory assessment and treatment orders (CATO) and the role of Duly Authorised Officers (DAO), and moral dilemmas that can arise as a consequence of CATOs used by DAOs are examined. The requirement for DAOs to act as patient advocates and to safeguard cultural beliefs are highlighted. The MHA promotes self responsibility and a treatment philosophy rather than detention of the mentally ill.
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Mackay, B. (2007). Leadership strategies for role development in primary health care nursing. coda, An Institutional Repository for the New Zealand ITP Sector, 11, 31–39.
Abstract: This paper has been developed from part of the writer's doctoral thesis on forces influencing the development of innovative roles in primary health care nursing. The focus of this paper is leadership strategies designed to reduce the issue of poor professional identity and support.
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Naidu, A. (2007). Is scholarship an integral component of advanced nursing practice? Whitireia Nursing Journal, 14, 50–53.
Abstract: This article defines scholarship and how it links to nursing. It explores how nurses perceive scholarship and how it can enhance their practice. While agreeing that scholarship plays a vital role in the image of nursing as a professional practice, the article's main focus is on scholarship as an integral component of advanced nursing practice.
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Crowe, M., Ward, N., Dunnachie, B., & Roberts, M. H. (2006). Characteristics of adolescent depression. International Journal of Mental Health Nursing, 15(1), 10–18.
Abstract: This is a descriptive study of the characteristics of depression in a sample of 121 adolescents attending an outpatient specialist adolescent mental health service in New Zealand. The adolescents were required to complete two self-report measures to assess presence of depressive symptoms, severity of depression, and particular characteristics of the depression. The findings revealed that irritability was the most common characteristic along with other interpersonal and thought processing symptoms. It is important that mental health nurses are able to identify the specific characteristics of adolescent depression that may differ from adult depression in order to manage this patient population effectively.
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Crowe, M., & Luty, S. (2005). Recovery from depression: A discourse analysis of interpersonal psychotherapy. Nursing Inquiry, 12(1), 43–50.
Abstract: This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions.
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