Litchfield, M. (1998). Case management and nurses. Nursing Praxis in New Zealand, 13(2), 26–35.
Abstract: The report of an exploratory study of current approaches to case management by nurses as requested by the College of Nurses Aotearoa New Zealand. It revealed different interpretations of nurse case management around New Zealand and in the US, UK and Australia. They differed according to the conceptualisation of health service design and delivery in the respective country. Case management in New Zealand in general presented nurse care management roles as an interface between the mangement of health service delivery and the peculiarities of the healthcare people received, holding the potential for achieving tailored, patient-centred care outcomes.
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Litchfield, M. (1998). Professional development: Developing a new model of integrated care. Kai Tiaki: Nursing New Zealand, 4(9), 23–25.
Abstract: An overview of the model of nursing practice and nurse roles derived through a programme of nursing research in the context of the policy and strategies directing developments in the New Zealand health system. The emphsis was on the health service configuration model presented diagrammatically to show the position of a new role of family nurse with a distinct form of practice forming the hub.
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Litchfield, M. (1998). The scope of advancing nursing practice. Nursing Praxis in New Zealand, 13(3), 13–24.
Abstract: An overview of the model of nursing practice and nurse roles derived through a programme of nursing research in the context of the changing New Zealand health system. The emphasis is on the complementary nature of the practice of family nurses taking a generic integrative service delivery hub role and the practice of other nurses advancing in specialist roles. Nursing care is presented as a professional, collective practice of registered nurses spread across all health service sectors and employment settings. Nurse roles are differentiated according to the interplay of two factors influencing the extent of practice autonomy the nurses assume (educationally supported) in responding to health need. A diagram depicts the interrelationship of competency and scope for the inclusive three different career trajectories of nurses advancing in practice. NOTE: This paper was published with an error in the title of the article (stated correctly on the journal contents page). An apology from the journal editor with an explanation of the importance of the use of the term ?advancing? and not ?advanced? was published in the subsequent issue (Nursing Praxis in NZ,14(1)).
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Litchfield, M. (1998). What is nursing research? P. Watson & M.Woods (Eds.), Waiora: Nursing research in Aotearoa/New Zealand, evolving a shared sense of our future. Proceedings of the Nursing Research Section/Te Runanga O Aotearoa (New Zealand Nurses' Organisation) conference, Wellington 26-27 March., .
Abstract: This conference paper outlines the nature of nursing research developing the distinct knowledge for nursing practice. It is presented as a cumulative process of knowledge development about health, practice and service delivery. Nursing research is illustrated by tracing a personal trajectory of research over 25 years that addressed questions relating to and derived from the practice of nursing.
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Litchfield, M. (1997). The process of nursing partnership in family health (Vol. 4).
Abstract: The study reconceptualises the process of nursing practice where health is expanding consciousness. The praxis methodology and design derive from the findings of the previous study (Litchfield, 1993) through which a framework for personal practice was articulated. The philosophical premises were hermeneutic and dialogic reflecting a narrative orientation within a participatory paradigm. Ontology and epistemology merge and language is fundamental. The findings from this subsequent study depict the process of modeling practice as a tetrahedron to show inter-relatedness of four facets, each defined completely by the others: partnership, dialogue, pattern recognition and health as dialectic. Five young families with complex health circumstances were preferred by Plunket Nurses and visited at hole to talk about health and the family. Th e process of health patterning ended with indication of insight as the potential for action; the partnership ended as the closure of the initial contract to provide a summary text to the family. Transformative change in family living was identified. The continuous analysis of the scripts of the evolving conversations and summary text showed the relational, dialogic processes were identified as vision – finding purpose to act in the here-and-now against the backdrop of past and potential of the future; and community – a sense of being connected, participant and relevant in society. This process of research, as if practice, presented health and caring as synonymous and core of the discipline of nursing
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Litchfield, M. (1997). The language of nursing practice in hospitals. (Vol. Proceedings of the National Nursing Informatics Co).
Abstract: A paper presenting the findings of a small research project involving a group of self-selected senior nurses of Wellington Hospital to explore the nature of nursing practice in the care and management of hospitalised patients and to formalise the language that would acknowledge its significance in the current effort of hospitals to define patient care pathways. The nature of hospital nursing practice was described in themes of a generic process of nurse-patient care that articulates a distinct specialism of hospital nursing, whatever the hospital department in which nurses hold positions.
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Litchfield, M., Clarke, M., Edwards, R., Richardson, F., Tansley, R., & Woodman, K. (1995). A description of the needs of people with cancer and support people. Ph.D. thesis, , .
Abstract: The report of a research project commissioned by the Wellington Division of the New Zealand Cancer Society to provide a foundation for policy to give direction to development of its services. The research approach and methodology had an ecological theory foundation. It involved a survey and in-depth interviews with people with cancer and those caring for them to understand their experience. Needs were identified from the data and presented according to three distinct phases in the course of living with cancer. People moved from the shock of diagnosis, through the time of treatment when usual living was suspended and focus narrowed on the intensive fight against the disease, then into a very different phase of on-going ?wait-and-see? time requiring a new way of living with uncertainty for both patient and carers. The last phase was where most of the unmet needs lay. Recommendations were made for services to provide a continuous caring relationship for patients and carers with a knowledgeable person from the point of diagnosis.
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Litchfield, M., & McCombie, M. - L. (1994). The introduction of an advanced nurse practitioner role in mental health: report of the evaluation research undertaken for the Mental Health Service of Capital Coast Health Ltd. Ph.D. thesis, , .
Abstract: The study was commissioned to define the role of Advanced Nurses Practitioner to inform the establishment of a clinical career pathway. Four new, loosely defined ANP positions were created and the role evolution over three months was described. The impact on the multidisciplinary team functioning was to be given particular attention. The research design was developed in collaboration with the ANP Project Team of the service. Data were derived from surveys of nurses in the units and other staff before and at the end of the 3 months period; interviews with the ANPs and official client advocates; daily journals and weekly logs kept by the ANPs; statistical records of patient loads and staffing. The findings presented the role as the interface of unit management and direct client care, with the ANPs orchestrating the activities of the unit. The ANPs developed the role differently according to quite distinct conceptualisations of nursing which influenced whether direct client care was pivotal or peripheral to the role. This had an effect on whether the strains of the service were seen as inhibitory of focal to the development of the ANP practice. There was little change in unit staff satisfaction. Attempts to incorporate client advocacy to determine change in client satisfaction were unsuccessful. The ANPs used the research as a process of role development
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Litchfield, M., Connor, M., Eathorne, T., Laws, M., McCombie, M. - L., & Smith, S. (1994). Family nurse practice in a nurse management scheme: a pilot service study for the health reforms. Ph.D. thesis, , .
Abstract: The independently funded 10 month pilot project demonstrated the autonomy of nursing practice for a new role family nurse. The findings were presented as the health experience of families in strife with complex health circumstances, a description of a beginning model for the nursing practice that addressed the needs of these families as their circumstances changed over time, and its cost-effectiveness. A caseload of nineteen families was found to be optimum. The evaluation research continued throughout as a form of praxis expressed as health patterning, a methodology developed in previous research (Litchfield, 1993). The family nurse'spractice demonstrated qualities common to all nurses: the caring relationship and fiscal responsibility. The unique practice was characterised by a professional partnership of limited duration: the families referred to the service in a predicament of strife, trapped in the immediate present, gained a view to a future, moved towards assuming control over health circumstances, seeking and using services with discernment, and increasing community as family/group members and citizens. Cost containment was achieved through: a) development of a co-operative approach amongst family members, between families and professionals, and amongst all health workers, and b) the families discerning use of services by anticipating a future. Through one family case, cost of saving over the 7 months with the family nurse was estimated as $4000, a possible saving of $16000 over 13 months if the family nurse had been involved earlier, and projected savings in the long term of over a million dollars. The satisfaction of clients, nurses and professionals was shown. The service was positioned within the new health system of health reforms
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Litchfield, M. (1994). Viewpoint: Telling nursing stories. Kai Tiaki: Nursing New Zealand, 2(4), 28.
Abstract: A brief critique and comment on the ethical implications of nurse researchers using methodology that involves soliciting personal experiences of patients and subsequently publishing them as stories.
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Litchfield, M., Connor, M., Eathorne, T., Laws, M., McCrombie,, & Smith, S. (1993). Direction for nursing practice and service delivery in the New Zealand health reforms. Report of the pilot study of the Wellington professional nurse care management project. Ph.D. thesis, , .
Abstract: Nursing practice as the process of health patterning with families in complex health circumstances was made explicit through a method of research praxis. Findings include cost in relation to quality of Nursing care. The research provides direction for development of integrated health care with the introduction of the family Nurse in a Nurse Care Management Scheme
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Litchfield, M. (1993). The process of health patterning in families with young children who have been repeatedly hospitalised. Ph.D. thesis, , .
Abstract: An exploration of the nature of nursing knowledge in practice. The praxis methodology was inspired by the Newman's theory of health as expanding consciousness and evolved through the process of the research. The methodology was eventually presented as both the process of research and practice. Five families were visited in their homes five times to talk about what was going on for them. All were experiencing a time of great upheaval in family life. After three visits a summary text was constructed merging researcher statements and parent quotes and given to the families. Through the subsequent reflective discussion significant insights into family pattern were shown in statements of intended action to change how health matters were managed with greater facility in family living. The process was presented as five themes with descriptors representing a non-linear, discontinuous progression: A moment of partnership: parameters of entry and closure, a timing of upheaval in family life, and an in-forming capacity through the bringing together of family story-telling and researcher's theory. An evolving dialogue: a progressive flow of enfolding and unfolding, and its embeddedness in contexts of socio-economic status, gender and health care culture. Recognising pattern: incidental revelations and an all-encompassing insight as the potential for action. Expanding horizon: moving from being on a treadmill trapped in the present without vision to having a view to a future, the presence of past and future. Increasing connectedness: a sense of inclusion, inter-dependence and generally, transformation in family life. This was a framework for personal practice
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Litchfield, M. (1993). Priorities for research. kai Tiaki: Nursing New Zealand, 1(8), 28–30.
Abstract: An article adapted from the author's contribution as an invited member of the International Panel of Nurse Researchers leading the Special Research Seminar of the 1993 International Council of Nurses Quadrennial Congress, Madrid, Spain. The priorities of nursing research in New Zealand were derived from the findings of a semi-structured survey of the opinions of nurses in academic settings.
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Litchfield, M. (1992). Computers and the form of nursing to come. (Vol. Proceedings of the Inaugural National Nursing Info, pp. 81–90).
Abstract: A paper presented at the annual conference of Nursing Informatics New Zealand (subsequently incorporated into the collective organisation, Health Informatics NZ).
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Litchfield, M. (1992). Computers and the form of nursing to come. International Journal of Health Informatics, 1(1), 7–10.
Abstract: An invited paper for the initial issue of the IJHI. Adapted from a paper presented at the annual conference of Nursing Informatics New Zealand, 1991 (subsequently incorporated into the collective organisation, Health Informatics, NZ.
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