Litchfield, M. (2006). Towards a people-pivotal paradigm for healthcare: Report of the Turangi primary health care nursing innovation 2003-2006.
Abstract: This report presents the findings of the developmental evaluation programme for the three-year innovation project. It includes the model of the integrative nursing service scheme with mobile whanau/family nurses as the hub of healthcare provision for a new paradigm of service design and delivery spanning primary-secondary-tertiary sectors. The form of healthcare the local people received, the nature of the nursing practice and role, service delivery and employment parameters required to support the nurses in practice are presented. The service configuration model subsequently gave the structure to Lake Taupo Primary Health Organisation with the hub of family nurses with a mobile comprehensive practice.
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Henty, C., & Dickinson, A. R. (2007). Practice nurses' experiences of the Care Plus programme: A qualitative descriptive study. The Royal New Zealand College of General Practitioners website, 34(5), 335–338.
Abstract: The aim of this small qualitative descriptive pilot study was to describe the experiences of practice nurses delivering the Care Plus programme within the general practice setting. Care Plus was introduced into Primary Health Organisations (PHOs) in 2004. This programme encourages more involvement from practice nurses in chronic care management. For many New Zealand practice nurses this is a new role. This study, carried out prior to the larger Care Plus implementation review (2006), provides an insight into the nursing experience of implementing Care Plus and provides a basis for future studies with regard to the nurse's role within the Care Plus programme.
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Giddings, D. L. S., & Grant, B. M. (2007). A Trojan Horse for positivism? A critique of mixed methods research. Advances in Nursing Science, 30(1), 52–60.
Abstract: This paper presents an analysis of mixed methods research, which the authors suggest is captured by a pragmatically inflected form of post-positivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favour the forms of analysis and truth finding associated with positivism. The authors anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, they recognise that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.
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Primary Health Care Nurse Innovation Evaluation Team,. (2007). The evaluation of the eleven primary health care nursing innovation projects: A report to the Ministry of Health. Wellington: Ministry of Health.
Abstract: In 2003, as part of implementing the Primary Health Care Strategy, the Ministry of Health announced contestable funding, available over three years, for the development of primary health care nursing innovation projects throughout Aotearoa/New Zealand. The Ministry looked for proposals that would: support the development of innovative models of primary health care nursing practice to deliver on the objectives of the Primary Health Care Strategy; allow new models of nursing practice to develop; reduce the current fragmentation and duplication of services; and assist in the transition of primary health care delivery to primary health organisations. This report describes the findings from the evaluation of the 11 primary health care nursing innovations selected for funding by the Ministry of Health. It provides an overview of the innovations' success and of the lessons learnt from this policy initiative.
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Carryer, J. B., Gardner, G., Dunn, S., & Gardner, A. (2007). The core role of the nurse practitioner: Practice, professionalism and clinical leadership. Journal of Clinical Nursing, 16(10), 1818–1825.
Abstract: This article draws on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. A study jointly commissioned by both countries' Regulatory Boards developed information of the newly created nurse practitioner role, to develop shared competency and educational standards. This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner programme curricula and interviews with 15 nurse practitioners from the two countries. The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care.
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Pirret, A. M. (2007). The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making. Intensive & Critical Care Nursing, 23(3), 145–155.
Abstract: The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand. Quantitative analysis showed that nurses articulated a low to medium level of knowledge of respiratory physiology. Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved.
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Polaschek, L., & Polaschek, N. (2007). Solution-focused conversations: A new therapeutic strategy in Well Child health nursing telephone consultations. Journal of Advanced Nursing, 59(2), 111–119.
Abstract: This paper reports a study to explore Well Child nurses' perceptions of outcomes resulting from the use of solution-focused conversations in their telephone consultations with clients. The standard problem-solving approach used to address physical issues is less effective for various non-physical concerns, where different communication strategies may be helpful. In this qualitative, action-oriented study, a small group of Well Child telenurses in New Zealand was introduced to a specific communication strategy, called 'solution-focused conversations', during 2005. They applied this approach in their practice and then reflected together on their experiences in focus groups. The nurses considered that the solution-focused conversations enabled clients to: recognise the nature of the parenting issue of concern that had motivated their call; identify more effective parenting practices to address specific issues with their child; increase their confidence in their own parenting capabilities. This study suggested the value of learning a specific communication strategy for the practice of a group of Well Child telenurses.
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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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Jamieson, I. (2008). The mobile operating theatre project. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp.81-97). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter firstly presents the development of a mobile operating theatre project, which was implemented in 2002 to provide rural day-stay surgery. Secondly, it discusses the process and findings of a research project undertaken with the purpose of evaluating a perioperative (theatre and recovery) reskilling programme offered to 42 rural nurses from nine secondary hospitals, conducted over nine months in 2001. The training was given to nurses prior to the introduction of a mobile operating theatre service, and was seen as a key part of the service contract.
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Pedersen, C. (2008). Nurse-led telephone triage service in a secondary rural hospital. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 99-110). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter describes the development of a nurse-led after-hours telephone triage service in a rural secondary hospital in the Hawke's Bay District Health Board area. This service was a response to the health restructuring in the 1990s, which had led to the shift of secondary services out of the rural areas, and workforce recruitment issues. Secondly, it discusses the process and findings of a research project undertaken to identify and describe telephone callers' reported outcomes after using the service. The study found a high level of satisfaction amongst callers and a high level of compliance to advice.
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Hale, R. (2008). Older patient perceptions of transitional care. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 147-152). [Dunedin]: Rural Health Opportunities.
Abstract: The author describes transitional care as undertaken within the Waikato District Health Board health care environment. Transitional care supports people moving between acute health care (inpatient) and primary health care (home). It is a rehabilitative model based in smaller, predominantly rural communities to enable the older person to actively work towards recovery of functional ability within their own environment. Research indicates this rehabilitation model is applicable to the rural situation and satisfaction levels of the patients and caregivers tends to be positive.
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Peri, K., Kerse, N., Kiata, L., Wilkinson, T., Robinson, E., Parsons, J., et al. (2008). Promoting independence in residential care: Successful recruitment for a randomized controlled trial. Journal of the American Medical Directors Association, 9(4), 251–256.
Abstract: The aim of this study was to describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial. A global impression of staff willingness to facilitate research was gauged by research nurses, facility characteristics were measured by staff interview. Forty-one (85%) facilities and 682 (83%) residents participated, median age was 85 years (range 65-101), and 74% were women. Participants had complex health problems. Recruitment rates were associated (but did not increase linearly) with the perceived willingness of staff, and were not associated with facility size. Design effects from the cluster recruitment differed according to outcome. The recruitment strategy was successful in recruiting a large sample of people with complex comorbidities and high levels of functional disability despite perceptions of staff reluctance. Staff willingness was related to recruitment success.
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Johnson, H. (2008). Clinical trials in the intensive care setting: A nursing perspective. Ph.D. thesis, , .
Abstract: As carers of patients who are clinical research participants, nurses' contribution to the success of clinical trials is acknowledged in the literature. Ethical dilemmas and challenges that clinical trials may present for nurses are also recognised. Although there is some discussion regarding these issues, few studies explore and identify the perceptions of intensive care nurses regarding clinical trials and how they may impact on nursing practice. This thesis explores and describes the viewpoints and experiences of sixty intensive care nurses from a tertiary level referral centre in New Zealand engaged in clinical research activities. The descriptive study utilised a self-administered questionnaire to gather information regarding nurses' roles in clinical trials, associated issues encountered and contributory factors, and the impact of issues on nursing practice, stress and satisfaction levels. Suggestions for potential strategies to minimise the impact of issues on nurses' practice were also sought. Descriptive statistical and content data analyses identified three key areas in which nurses' encounter issues associated with clinical trials and their practice: nurses' workload; ethical concerns; educational preparation and support. The findings indicate that, when issues exist in these areas, routine patient care can be delayed, the enactment of nurses' patient advocacy role can be affected, and nurses' stress and satisfaction levels can be negatively impacted upon. The perceptions of a group of intensive care nurses who are enveloped in the daily balance of patient care, the need for clinical research, and their professional obligations are discussed in this thesis. While the study's findings are reflective of one group of nurses in a distinct practice setting, their experiences can prompt other nurses, research teams and clinical leaders to reflect upon their own clinical research environment.
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Gardner, A., Hase, S., Gardner, G., Dunn, S., & Carryer, J. B. (2008). From competence to capability: A study of nurse practitioners in clinical practice. Author copy available 12 months after publication from QUT ePrints, 17(2), 250–258.
Abstract: This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. A secondary analysis of data obtained from the interviews with 15 nurse practitioners working in Australia and New Zealand was undertaken. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. This study suggests dimensions of capability need to be considered in the education and evaluation of nurse practitioners.
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Tweed, C., & Tweed, M. (2008). Intensive care nurses' knowledge of pressure ulcers: Development of an assessment tool and effect of an educational program. American Journal of Critical Care, 17(4), 338–347.
Abstract: The aim of this study was to assess intensive care nurses' knowledge of pressure ulcers and the impact of an educational programme on knowledge levels. A knowledge assessment test was developed. A cohort of registered nurses in a tertiary referral hospital in New Zealand had knowledge assessed three times: before an educational programme, within two weeks after the programme, and 20 weeks later. Completion of the educational programme resulted in improved levels of knowledge. Mean scores on the assessment test were 84% at baseline and 89% following the educational programme. The mean baseline score did not differ significantly from the mean 20-week follow-up score of 85%. No association was detected between demographic data and test scores. Content validity and standard setting were verified by using a variety of methods. Levels of knowledge to prevent and manage pressure ulcers were good initially and improved with an educational programme, but soon returned to baseline.
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