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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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Chenery, K. (2007). Building child health nurses' confidence and competence. Kai Tiaki: Nursing New Zealand, 13(5), 26–38.
Abstract: This article describes the development of the Generic Orientation Programme, Child Health Nursing and its perceived impact on practice after ten months, through two simultaneous evaluation surveys, seeking the views of programme participants and their nurse managers. The programme aims to equip the newly appointed RN in the child health cluster or the nurse working in a non-designated children's area with the knowledge and skills to safely care for children. These include basic anatomical and physiological differences; fluid and electrolyte management; safe administration of medication; pain management; recognition of the seriously ill child; and building partnerships with children and their families. A survey instrument eliciting qualitative and quantitative responses was used. The majority of nurse respondents believed they had gained new knowledge and described how they were incorporating it into everyday practice. Similarly, several nurse managers observed that nurses' clinical knowledge and skills had improved since attending the programme. In particular, responses from those working in non-designated children's areas suggested the programme had provided them with greater insight into the care of children.
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Hughes, F., & Farrow, T. (2007). Caring for obese patients in a culturally safe way. Kai Tiaki: Nursing New Zealand, 13(4), 14–16.
Abstract: The authors review the contemporary notion of obesity and suggest that the nursing approach, with an emphasis on treatment, are shaped by a culture located within “western” views of ideal body shape. The biomedical framework regards obesity as disease and obese people as the cause of their own health problems. The authors note varying cultural interpretations of obesity, and suggest that by viewing obesity as a disease, the cultural, social or economic determinants of obesity are not acknowledged. Nursing needs to broaden the concept of the categories of difference to respond in a culturally safe way to obesity. Cultural safety asks that nurses care for people “regardful” of difference. This means nurses must reflect on the care given, so that the biomedical model is not just replicated. Nurse-led clinics offer an opportunity for practices based on nursing values of care and cultural safety. Such clinics are based on nursing's social model of health, rather than a biomedical, disease-focused model.
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Shaw, S. (2007). Constructing media images of nursing: How does the media represent nurses when reporting on nurse prescribing? Kai Tiaki: Nursing New Zealand, 13(1), 16–18.
Abstract: This research presents a discourse analysis of articles published in the New Zealand Herald between October 1999 and September 2005. The terms “nurse prescribing” and “prescribing fights” identified seven articles published which referred specifically to this issue. They were predominantly editorial comments and statements attributed to senior doctors. Examples of comments from these articles are presented and discussed in this article, and three inter-related themes are identified – competence, responsibility and competition. Discussion on competence centred on education, skill and experience level of nurses, as described by editorial comment and senior doctors. Positive international research and experience of nurse prescribing did not feature. A number of comments in the articles analysed could be seen to represent concerns about competition between medicine and nursing. One interpretation of the comments contained in these articles is to see medical practitioner groups defending their status and desire to define and control nursing practice. The media has the power to select the information conveyed and, in these instances, appears to have demonstrated a bias towards the medical community's perspective.
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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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Surtees, R. (2007). Developing a therapeutic alliance in an eating disorders unit. Kai Tiaki: Nursing New Zealand, 13(10), 14–16.
Abstract: The author presents the approach of a nursing team at Christchurch's Princess Margaret Hospital, in the regional specialist service for people with anorexia nervosa. This unit provides the only specialist inpatient unit in the country, consisting of a six or seven-bed facility that shares a unit with a mother and baby unit. A multidisciplinary team of psychiatric nurses, dietitians, occupational therapists, psychiatrists, psychologists and social workers all make significant contributions. The Christchurch unit uses a cognitive-behavioural therapy model (CBT) across the disciplines, a multidimensional approach incorporating psychotherapeutic, psychoeducational, biomedical and behaviourist paradigms. This occurs within a “lenient flexible approach”. Within the Unit, the eight nurses constitute what could be seen as an “intra”-disciplinary team within the wider “inter”-disciplinary or MDT team. They apply an evidence-based nursing approach with a commitment to partnership and advocacy with their patients. They use collaborative techniques for defining shared goals, and the careful management of the introduction of food. As one of the team members, the author envisages that the job of specialised nurses is to form a therapeutic alliance with patients, which takes account of the dynamic ways that patients may negotiate their own complex understandings of health, care, and recovery.
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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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Bradshaw, W. (2007). Helping clients move towards health change. Kai Tiaki: Nursing New Zealand, 13(7), 16–18.
Abstract: The author reflects on his use of the American psychotherapist James Prochaska's stages of change theory. This model deals with individuals and how they move towards change, through stages of pre-contemplation to maintenance of changed behaviours. He presents examples of his use of the model with clients, when dealing with issues of smoking cessation and weight loss. He analyses his practice and interactions with clients, and affirms that stages of change model can be a useful tool to bring about change within clients. He suggests it gives clients the opportunity to contemplate change and gives nurses working in health promotion the opportunity to be part of the change process.
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Floyd, S., & Meyer, A. (2007). Intramuscular injections: What's best practice? Kai Tiaki: Nursing New Zealand, 13(6), 20–22.
Abstract: The aim of this research project was to explore issues around preferred injection site, intramuscular injections injection technique, particularly Z-tracking, and the wearing of gloves while administering intramuscular injections. The researchers conducted a literature search which revealed little published information on the use of intramuscular injections, despite them being part of everyday nursing practice. The guidelines for evidence-based practice in relation to intramuscular injections are reviewed and discussed. A survey of registered nurses on intramuscular injections sites and technique was conducted. An anonymous questionnaire, accompanied by an explanatory letter, was sent to 173 registered nurses working in general practice, prisons, and to community and inpatient mental health nurses. Response questionnaires were collated and a thematic analysis was undertaken. This research findings show that, despite the known iatrogenic complications which could occur when administering intramuscular injections, some registered nurses' practice does not appear to take this in to consideration. Furthermore, the majority of registered nurses did not use gloves and Z-tracking was not widely used among the sample group. The researchers conclude that although intramuscular injections are a fundamental skill, there appears to be limited research and evidence to support best practice. Education and support to change practice to reflect current research is paramount, if registered nurses are to remain competent.
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Tritschler, E., & Yarwood, J. (2007). Relating to families through their seasons of life: An indigenous practice model. Kai Tiaki: Nursing New Zealand, 13(5), 18–3.
Abstract: In this article the authors introduce an alternative way that nurses can be with families, using a relational process that can enhance nurses' responses when working with those transitioning to parenthood. Seasons of Life, a framework adapted from the Maori health model He Korowai Oranga, emerged from practice to offer a compassionate and encouraging stance, while at the same time respecting each family's realities and wishes. The model allows the exploration of the transition to parenthood within a wellness model, and takes a strengths-based approach to emotional distress. This approach provides a sense of “normality”, rather than of pathology, for the emotions experienced by new parents. The specific issues men may face are discussed, where despite recent culture change that allows men a more nurturing parental role, there is still no clear understanding of how men articulate their sense of pleasure or distress at this time. Practitioners are encouraged to examine their own assumptions, values and beliefs, and utilise tools such as reflective listening, respect, insight and understanding. The most significant aspect of relationship between nurse and parents is not the outcome, but how nurses engage with families. Examples from practice will demonstrate some of the differing ways this relational process framework has been effective.
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Evans, S. (2007). Silence kills: Challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16–19.
Abstract: The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals.
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Warren, B. L. (2007). Using paracetamol before immunisation: Does it work? Kai Tiaki: Nursing New Zealand, 13(5), 24–26.
Abstract: The author presents a review of evidence on the prophylactic use of paracetamol prior to infant and child immunisation. The research was prompted when the Otago District Health Board was planning its Meningococcal B strategy. The evidence suggests that it was appropriate when the whole cell pertussis vaccine was used, but it was not recommended since the introduction of better vaccines such as acellular pertussis with fewer antigens and fewer side effects. Paracetamol may still be given orally to treat pain and fever that occasionally follows vaccination. Paracetamol pharmacology is presented, along with alternatives to paracetamol.
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Arcus, K. J., & Wilson, D. (2006). Choosing Whitireia as a political act: Celebrating 20 years of a nurse education at Whitireia Community Polytechnic 1986-2006. Whitireia Nursing Journal, 13, 12–24.
Abstract: In 2006, Whitireia Community Polytechnic celebrates 20 years of tertiary education. Nursing was one of the first courses to start at the new Parumoana Community College in February 1986. Oral histories, gathered from the women who have been the leaders of the undergraduate nursing programme throughout these two decades, form the basis of this article.
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Pool, L. (2006). Why do young people choose nursing as a career? Whitireia Nursing Journal, 13, 25–33.
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Pearson, J. R., & Holloway, K. T. (2006). A postgraduate primary health care programme for experienced registered nurses and newly graduated nurses. Whitireia Nursing Journal, 13, 44–52.
Abstract: This paper outlines the historical development of the Postgraduate Certificate in Primary Health Care Specialty Nursing programme. The paper discusses the multiple contextual considerations for the programme in terms of New Zealand health policy direction, academic level, and appropriate level of competency development for nurses new to primary health care and newly graduated nurses.
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