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Robertson, A. M. (2006). Meeting the maternity needs of rural women: Negotiating the reality of remote rural nursing and midwifery practice. Ph.D. thesis, , .
Abstract: Recent changes to the way that health services are provided and issues related to the rural health workforce are creating an international crisis in the availability of rural maternity care. International trends show a workforce decline in rural general practitioner obstetric specialists and rural midwives, as well as a decline in rural births. The aim of this study is to highlight the maternity needs of rural New Zealand women. Further, it discusses how the changes to maternity services in New Zealand, over the last sixteen years, have impacted on the rural nurse and midwife role and therefore on service provision. This information is intended to identify issues that could be used as the basis for development of a uniquely rural model of maternity care.
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Cleaver, H. (2005). Reflections on knowing, not knowing and being in palliative care nursing. Ph.D. thesis, , .
Abstract: The author notes that responses to questions from dying people and their families are as individual as each nurse, patient, family member, or situation. This is well recognised and an unspoken truth in palliative care practice. This paper explores the subjective nature of knowledge in palliative care generated through capturing moments of practice and subsequent reflections. This demonstrates how the author uses her model of care to open a space that enables the person and their family to find meaning from their experience and articulate what they need at the time. The author identifies her interest in the paradoxical reality of knowing and not knowing and describes how that paradox contributes to her role in supporting individuals' needs within their realities.
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McKerras, R. (2005). Waiting in the emergency department – it doesn't have to take all day. Ph.D. thesis, , .
Abstract: This thesis explores the nature of the emergency department environment as it continues to challenge emergency nurses to meet the health needs of an increasingly complex emergency department population. The emergency nurse is also facing conflict and challenge with regard to workplace safety and patient rights. The author suggests that, until recently, very little debate or consideration has been given to the moral dilemmas raised in the ability of emergency department staff to deliver timely and appropriate care in an overcrowded environment. She goes on to say that, in New Zealand, there is no national consistency with regard to the waiting crisis, no national guidelines and no national consensus putting the emergency nurse at risk. This thesis argues the need to acknowledge waiting times as a significant safety issue at a national level as increasing waiting times continue to impact on patient outcomes and nursing practice. It challenges current practice, in particular the role of the emergency nurse and the potential to legitimise expansion of the role to improve the patient experience of waiting in the emergency department.
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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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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.
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Tucakovic, M. (2001). Nursing as an aesthetic praxis. Ph.D. thesis, , .
Abstract: This thesis focuses on the experience of being human as process in order to reveal being. Illness and health are seen as reflections of this process of revelation. This work argues that health and illness are physical expressions of consciousness and therefore an outcome of what a human being has thought. In this way, this work shows how thought/intent serves to create life in the moment. In this understanding lies the potential to change reality, to change life. The thesis identifies self-responsibility as the key to changing consciousness. Taking responsibility for the creation of one's reality eliminates the human tendency to blame another for what is experienced in life. To that end, this work argues, we are each free to choose what is felt in response to life. In so doing, we can become conscious that life is a choice, that is to be approached from either the position of perfection, or excellence. The author proposes that, in the understanding that human beings are the creators of their reality, it is possible to conceive of care in nursing that is directed at changing thinking/thought. Such change would be to focus on the excellence of life, and in that way enact care in nursing that is an enabling through a process of being that is an emotional allowance in response to life. To this end, this work is titled Nursing as an Aesthetic Praxis. The aesthetic is emotion and feeling. Praxis, is presented in its dialectical relationship of thought and action that is then bound to emotion and feeling in such a way that it illuminates the nature of thinking. This way of thinking, this work shows, is transformatory. Where transformation is a process of being that as a state of excellence is one of incremental human freedom accompanied by incremental responsibility.
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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.
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Grayson, S. (2001). Nursing management of the rheumatic fever secondary prophylaxis programme. Ph.D. thesis, , .
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Isaac, D. (2006). Passionate dedication: A qualitative descriptive study of nurses' and hospital play specialists' experiences on a children's burn ward. Ph.D. thesis, , .
Abstract: A qualitative descriptive approach was undertaken to explore the experience of eight registered nurses and two hospital play specialists who care for children hospitalised with burn injuries. The research participants were recruited from a paediatric ward that offers centralised specialty care to children with burns. Emerging out of the data was the over-arching theme of 'passionate dedication' that shows the nurses and hospital play specialists genuine compassion and commitment to meet the needs of the children with burns. The findings of the study reveal that the participant's dedication is shaped and determined by a dynamic process that involves having professional integrity and in-depth knowledge of caring for children and burn management. The nurses and the hospital play specialists have a common understanding of what their role entails and the skills required to provide quality care and support to the children and the children's family. On a personal and professional level the participants encounter several challenges in this care context that are physically and emotionally overwhelming. Despite becoming overwhelmed the participants are revealed as being resourceful and resilient in their aptitude to find ways that enable them to cope and get through. The author suggests that this study supports international literature that suggests that caring for children with burns is equally rewarding, as much as it is physically and emotionally demanding. The author identifies that the implication in this study for the organisation is to seriously consider issues regarding productivity and efficiency of the workforce with acknowledgement that nurses and hospital play specialists cannot do this emotional work without effective systems of support in place.
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Carter, T. (2000). The places we will go.
Abstract: The author examines how writing shapes her practice and how she nurses, her way of being and doing. She notes that “as human beings we cannot be broken into subsets, my personal and professional being inform each other, therefore you will find woven into the fabric of this paper my personal and professional becoming united by the dominant thread of nursing”. The paper is structured using the different phases of her career as a staff nurse, nurse practitioner and charge nurse. In each section she has linked the stories of children and young adults with reflections on her writing and how it has impacted her practice. She goes on to say that question and reflection are vital adjuncts to nurses' development as individual practitioners and to the profession. They facilitate journeying past the superficial into the deep of a relationship with patients and colleagues. She identifies a responsibility as nurses is to engage with the individual and help them find a space where they can regain a sense of hope and personal power. This paper follows the author's journey, leaving her with a clearer understanding of who she is and how she nurses.
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Weidenbohm, K. (2006). Pioneering rural nursing practice: An impact evaluation of a preventive home visiting service for older people. Ph.D. thesis, , .
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Morrison, M. (2003). Posthuman pathology: A postmodern art project located in critical care. Ph.D. thesis, , .
Abstract: The author's art project “Posthuman Pathology” is a postmodern examination of the resolutely modernist culture of critical care medicine. She uses conceptual art practices in conjunction with the techniques of anti-aesthetics in order to dismantle, open out and critique ideas which are foundational to the culture of critical care.
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Becker, F. (2005). Recruitment & retention: Magnet hospitals. Ph.D. thesis, , .
Abstract: International nursing literature indicates nursing shortages are widely recognised; however efforts to remedy poor recruitment and retention of nurses have been largely unsuccessful. This paper presents the predominant factors influencing poor recruitment and retention of nurses, such as: the image of nursing as a career, pay and conditions of employment, educational opportunities, management and decision making, and low morale and then explores how Magnet hospitals address these factors. During the 1980s, several hospitals in the United States were identified as being able to attract nursing staff when others could not, they became known as 'Magnet' hospitals. The American Nurse Credentialing Centre developed the Magnet Recognition programme to accredit hospitals that meet comprehensive criteria to support and develop excellence in nursing services. Magnet hospitals not only attract and retain satisfied nursing staff, but also have improved patient outcomes compared to non-Magnet hospitals, such as decreased patient morbidity and mortality and increased patient satisfaction. The successes of the Magnet Recognition programme in recruitment and retention of nurses is discussed in relation to its transferability outside of the United States, particularly to New Zealand as a way of improving recruitment and retention of nurses here.
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Kinniburgh, L. (2007). Treaty of Waitangi education: A pakeha woman's reflections on her journey. Ph.D. thesis, , .
Abstract: This thesis uses an autoethnographic method to describe the author's personal journey and the influences on teaching the Treaty of Waitangi in the School of Nursing at Otago Polytechnic, from 1985 to 2005. The author starts this exploration as a beginning teaching practitioner in 1985, and continues on with her attendance at the original workshop for trainers by Project Waitangi in 1990. She discusses the influences of her studies towards a Bachelor of Arts at Otago University, through the development of School Charters which influenced her children's schooling and through the process of teaching and facilitating the workshops for Treaty education, until her position in the School of Nursing changed in 2005. She discusses through reflection, the personal influences, the socialisation process of teaching the history of Aotearoa New Zealand to students, the influences of nursing education on Treaty education, the influences of Irihapeti Ramsden's relationship to her journey and also her lecturers at university. She also traces her journey of beginning teaching practice. The author identifies this work as providing a starting place for potential research into the experiences and reflections of nurse educators over this period of time, and across other educational institutes and disciplines. The experiences of students from this teaching would also add to the profession's and the country's knowledge about the relationship of the Treaty of Waitangi to both education and health.
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Rayat, P. (2001). The relationship between job satisfaction and professional development in nursing: A socio critical outlook.
Abstract: Health reforms, reviews and restructuring are not new to New Zealand nursing. The author notes that changes in the environment have created many pressures on nursing as a profession. The profession is trying to deal with this turmoil in a responsible fashion. It is also trying to grow and develop at the same time. This research is focused on finding the relationship between job and professional development. It also highlights the factors that affect job satisfaction and professional development.
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