|
Brinkman, A. (2000). A study into the causes and effects of occupational stress in a regional women's health service. Ph.D. thesis, , .
Abstract: Hospital-based health systems have the potential to be high stress environments, as staff work towards meetings the many and varied demands of the patients and their families / whanau in a situation of limited resources and unpredictable workloads. Dealing with physical and emotional trauma, and the 'normal' exigencies of daily life in what may be a far from normal workplace may compound the stresses facing health workers. Nurses, who are often at the interface between patients and other health professionals, may be caught in a cross-fire of transferred stress while also coping with stressors associated with their jobs. As well as being likely to have a negative effect on their well-being and job satisfaction, any such compounding impact of stress and stressors could have adverse impacts on patients and their supporters. The primary focus of this study has been to identify stress levels among nurses in a woman's health service, and to establish the causes of elevated stress. All staff were surveyed (with a 68% response rate). Midwives made up the largest portion, followed by nurses, doctors, therapies, support and clerical groups. The Job Stress Survey (JSS) and the General Health Questionnaire – 12 (GHQ-12) were used to help detect emergent stressors, and stress effects that staff were experiencing at the time. Aggregate data was used, focusing on the six occupational groupings and the nine areas within the health service. Findings from the JSS confirm that the staff had experienced a number of stressors, while indications of deleterious mental health effects in some staff emerged from the GHQ-12 scores. Occupational stress is a subset of general stress, making it difficult to separate one from the other as spheres of our lives overlap and interact. The stressors that were identified should contribute to the discussions and policies that might abet the reduction of stress. On the other hand, it is not possible to attribute the effects describes by the GHQ-12 as being derived primarily from occupational stress. A stressed staff member, no matter what the source of their stress might be, still needs support in order to cope. The author notes that the negative outcomes of occupational stress manifests themselves in many ways such as; mistakes, absenteeism, horizontal violence, burnout and turnover. These all affect the quality of the patient care delivered, leading to decreased patient satisfaction and and need to be addressed for these reasons.
|
|
|
Egan, M. (1999). The nursing and midwifery practice structure at Healthcare Hawkes Bay: An evaluation and improvement process. Vision: A Journal of Nursing, 5(8), 27–29.
Abstract: This article describes the Nursing and Midwifery Practice Structure, which has been in place at Healthcare Hawkes Bay since 1996. It was developed to provide nurses and midwives in clinical positions with a professional development structure, and uses a framework to recognise and reward competence. It encourages clinical progression and was developed to link nursing competence with remuneration. The Practice Structure, based on the work of Patricia Benner (Benner, 1984), is made up of 4 levels: Beginner/Advance Beginner Practitioner, Competent Practitioner, Proficient Practitioner, Expert Practitioner. The Structure was reviewed in 1998, and a Steering Group was formed to collect feedback from nurses and midwives, identify areas of concern, and make recommendations for improvements. At the time of writing, these recommendations are being implemented and systems are being developed to ensure the Nursing and Midwifery Practice Structure continues to develop.
|
|
|
Fleming, V. E. M. (1994). Partnership, power and politics: feminist perceptions of midwifery practice. Ph.D. thesis, Author, Palmerston North.
Abstract: Provides an interpretative critique of the partnership of a group of independent midwives and their clients in urban NZ. Uses a theoretical basis grounded in the principles of feminism, incorporating aspects of critical social science and post-modernism, to underpin both the methodological approach and the data analysis. Utilises the concepts of subjectivity, power/knowledge and praxis as tools for analysis of data which is collected through semi-structured interviews.
|
|
|
Mulcahy, D. M. (2006). Journeys cross divides: Nurses and midwives' experiences of choosing a path following separation of the professions. Ph.D. thesis, , .
Abstract: In 2003 the Health Practitioners Competence Assurance Act was introduced and established separate regulatory authorities for nursing and midwifery. This study is designed to explore the experiences of dually registered practitioners affected by this divide, as now there are two separate and possible paths, and two corresponding sets of competencies to fulfil. The design for this qualitative descriptive study utilised the written and oral narratives of three practitioners affected by this professional regulation and demonstrated its impact on their career development. Individual storytelling, as narrative, provided a theoretical lens aiding insight into their experience and pattern of decision making. In addition, symbolic consideration of the study data was provided by collective storytelling via the perennial myth of the hero journey. Shifting professional ground following the Health Practitioners Competence Act 2003 generated a focus for the inquiry into practitioners' modes of adjustment. For the practitioners in the study, transition between the occupational roles of nursing and midwifery comprised the possible career trajectories. A status passage, as the process of change from one social status to another, is described and includes the transitional experience of anticipation, expectation, contrast, and change. The author suggests that the findings from this research provide illumination of the nuances of professional decision making as a lived experience, and highlight how these practitioners dealt with shifting meaning, values, awareness, choices, and relationships. Aspects of group agency and identity, change management, and professional role transition were revealed. Life pattern, revealed through narrative, was an important research construct for exposing the ways in which the participants negotiated change, and displayed the function of their thinking and reasoning through dilemmas. Perception of individual and group identity revealed attitudes of esteem to the dominant discourse, and exposed dynamic tension between work patterns and life stage. Renegotiating arrangements of personal and professional commitment resulted from this dynamic interplay, and the relationship to stress and burnout was explored.
|
|
|
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.
|
|
|
Robertson, A. M. (2008). Rural women and maternity services. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 179-97). [Dunedin]: Rural Health Opportunities.
Abstract: The author discusses the roles that nurses undertake in response to rural communities' health needs, focusing on the provision of maternity service. The author reviews structural changes such as the 1990 Amendment to the Nurses Act 1977 which, the author suggests, introduced a climate of professional rivalry, changes in funding that cut back general practitioners in the field, and the development of Lead Maternity Carers. Despite controversial developments, New Zealand maternity services have evolved to include a unique and internationally respected model of midwifery care. However, the author highlights several areas that limit the positive contribution of rural nurses and midwives. These include workforce recruitment and retention, equity of access, and issues around maintaining competency and education.
|
|
|
Scott, W. (2006). Listen to the beat of my heart: The lived experience of panic attack in undergraduate nursing students: An interpretive inquiry. Ph.D. thesis, , .
Abstract: This interpretive inquiry explores the lived experience of 3 undergraduate nursing students and one midwifery student who have panic attacks. The aim of the research is to give voice to these students and to raise awareness among nurse educators about the impact that panic attacks may have for them. The research question asks, “what is the lived experience of panic attack in undergraduate nursing students?” A semi structured interview was conducted with each student in order to gain significant data. The research identified four key themes implicit to the lived experience of panic attack analysis: Listen to the beat of my heart (embodiedness), fearfulness, shamefulness, and holding one's own (coping). The findings suggest that the lived experience of panic attack is embedded in the lifeworld of lived body, lived time, lived relation, and lived space. Panic attack affects students physically and emotionally and interpersonally. The significant finding is that nurse educators need be aware of the coping or non-coping strategies used by students and, most importantly, recognise the impact that panic attacks have on their study.
|
|
|
Smythe, E. (2003). Uncovering the meaning of 'being safe' in practice. Contemporary Nurse, 14(2), 196–204.
Abstract: This paper moves away from the prevalent discourse of competence to consider the meaning of the experience of 'being safe' within the context of childbirth. It offers findings from a doctoral study, informed by the philosophies of Heidegger and Gadamer. Following ethical approval, the data was collected in New Zealand by tape-recorded interviews of 5 midwives, 4 obstetricians, 1 general practitioner and 10 women. The method was informed by van Manen. The findings reveal that in seeking the meaning of being safe one needs to be aware that the unsafety may already be present in the situation. Practitioners may be able to do little to rectify the unsafeness. There is, however, a spirit of safe practice, explicated in this paper, that is likely to make practice as safe as it can possibly be. Wise practitioners are ever mindful that a situation may be or become unsafe, and are always aware of their own limitations.
|
|