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Key, R., Cuthbertson, S., & Streat, S. J. (1994). Feasibility of a nurse-based critical care follow-up clinic. Ph.D. thesis, , .
Abstract: We are about to implement a nurse-based critical care follow-up service and used a follow-up study of tracheostomy to determine the feasibility of such a service. Nine to 27 months median 14 after intensive care admission we attempted to follow-up 116 of our most severely ill survivors. Twenty six could not be found, 11 declined follow-up. A questionnaire, interview and limited examination were used to determine health status. Ten patients unable to come to a clinic were seen at home. Interview time varied between patients but 79 patients took 100 nurse-hours. Ninety percent of patients co-operated with respiratory function testing. Pulse oximetry identified one with severe chronic respiratory failure. In this highly selected group of patients with on going problems (perceived poor health, dependency, disability, changes in appearance, deterioration in personal relationships, poor sleep, pain, altered diet, unaddressed chronic health problems, poor access to health services, and continuing prescription medication) were common, and addressed to some extent by appropriate referral. Approximately 20% of patients reported improvement in their health and personal relationships after critical illness and half of the smokers had given up. Factors contributing to follow-up difficulty included distance, delay in initial contact, change of address (255 of this group), disability and poverty. A nurse-run critical care follow-up clinic is feasible, time consuming but productive. A register of current addresses and phone numbers is recommended. The optimal time for follow-up will vary with patients conditions but early follow-up with protocol- based lines of referral is recommended to reduce persistent health problems
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McManus, L. M., Cuthbertson, S., & Streat, S. J. (1998). When the lights went out in Auckland. Ph.D. thesis, , .
Abstract: As the clinical consequences of power failure in intensive care are seldom documented we reviewed the effects of a power failure on patient care, outcomes and the adequacy of our disaster plan. We reviewed clinical records of all ten patients in our department during a 20-minute total hospital power failure, determined the impact of the failure on the therapies being given, and the costs of failed equipment. We assessed the departments disaster plan and identified the causes of the power failure.Nine patients were intubated; six ventilated (one receiving nitric oxide) and three receiving continuous positive airway pressure. Two patients were ventilated by Servo 300,? which continued on batteries, the other four patients were ventilated manually. Six patients were receiving nine inotrope infusions through IMED Gemini,? (battery life 30 minutes). One patient was receiving high volume ultrafiltration using a Gambro? haemodialysis system, which failed. Blood flow to prevent clotting was maintained by turning the roller pump manually. All networked monitoring (SpaceLabs?) failed and three haemodynamically unstable patients were monitored by transport monitors (SpaceLabs Scout?). No patient suffered any ill effect. Failed electronic circuits cost $NZ11,724. The disaster plan was implemented and functioned well. The aged cables supplying Auckland Central failed during an El Nino summer. The hospital generators, supplying power to the city grid, failed to switch over to the hospital. During power failure infusion pumps should be only for inotropes. We now have external 12-volt battery backup. With good pre-planning, safe intensive care continued during a short power failure
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Pearce, L., Kirkham, S., & Cuthbertson, S. (1996). Quality of follow-up for self-poisoning patients after discharge from intensive care: 1996, one year later. Ph.D. thesis, , .
Abstract: In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care.
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Horsburgh, M. (1982). Using videotape to determine the validity of the evaluation instrument of assessing clinical competence of nursing students and the reliability of the raters in assessing the clinical competence of nursing students. Ph.D. thesis, , .
Abstract: A study to determine the content validity of an education instrument to assess the clinical competence of Comprehensive Nursing Students and the reliability of the Nursing Teachers using the evaluation instrument to assess student Nurses performance depicted on videotapes of simulated clinical situations. 24 of the Nursing Teachers in a school of Nursing rated student Nurses clinical performance in simulated videotaped clinical settings. One half of these Teachers assessed the students without a specific evaluation instrument and their assessments were compared with the Teachers using the existing evaluation for assessing Nursing students' clinical competence. The evaluation instrument was judged to be valid in terms of content by the Nursing Teachers taking part in the study. Rated reliability of observer agreement was not demonstrated with 24 Nursing Teachers rating 3 Nursing Students' clinical performance as videotaped in simulated clinical settings. The usefulness of videotapes for determining observer agreement and as a tool for use in staff training workshops, in relation to assessing clinical competence of Nursing Students is established
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McKegg, A. H. (1991). Ministering angels: the government backblock nursing service and the Maori health nurses, 1909 -1939. Ph.D. thesis, , .
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Wallace, S. (1987). The professionalisation of nursing 1900-1930. Ph.D. thesis, , .
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Palmer, S. G. (1993). Positively positive: an experimental evaluation of the Wellness Programme, Burnett Centre. Ph.D. thesis, , .
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Morrison, M. (1994). Body-guarded: the social aesthetics of critical care. Ph.D. thesis, , .
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Messervy, L. (1993). The rise of the independent nurse practitioner: a comparative study of independent nurse practitioners and nurses in traditional work places. Ph.D. thesis, , .
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MacManus, M. (1994). Reflective practice: teaching the practice of nursing. Ph.D. thesis, , .
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Howard, F. M. (1983). Staff – patient interaction patterns in hospital and community psychiatric facilities, a comparison. Ph.D. thesis, , .
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Kerslake, M. T. (1994). The nurse practitioner in the South Pacific region: concerns about this innovation. Ph.D. thesis, , .
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Hay, J. (1991). A needs assessment of and for people with head injuries in the greater Auckland area. Ph.D. thesis, , .
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Glasspoole, L. A. (1986). Psychotropic drug use with the elderly: nurse attitudes and knowledge levels. Ph.D. thesis, , .
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Caldwell, S. (1998). From “beloved imbecile” to critical thinker: producing the politicized nurse. Ph.D. thesis, , .
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