81,191 results

  • The Baby Friendly Hospital Initiative Implementing the Process in New Zealand

    Jackson, Christine (2005)

    Scholarly text
    Victoria University of Wellington

    The Baby Friendly Initiative is a global initiative jointly with the World Health Organization (WHO) and the United Nations (UNICEF). The Baby Friendly Hospital Initiative has become the primary intervention strategy for strengthening the capacity of national health systems to protect and promote breastfeeding. WHO supports committees coordinating the BFHI process by placing particular emphasis on developing core groups of trainers, at national and regional levels developing reassessment and monitoring tools, to ensure the Initiative’s continued integrity and credibility and broadening the Initiative. This is a reflective paper that has documented the implementation of Baby Friendly Hospital (BFHI) in New Zealand. It describes the collaborative processes that were necessary to achieve such a goal and the sheer determinedness of a few. It demonstrates that with collegial passion and partnership, success and a political stance can be achieved from which health policy and reform can be directed. The International context is outlined simplistically with an explanation of the important documents and global initiatives which underpin the implementation of BFHI. The scientific evidence supporting the Ten Steps to Successful Breastfeeding is documented so that the reader has an appreciation of the importance of BFHI and good health. Background to the implementation of BFHI in New Zealand has been acknowledged. This process has been observed by the international community and seen as inspirational. With ministerial commitment and support the international documents have been rewritten to fit our unique maternity system, presented to the New Zealand community and instituted into health reforms. To conclude this paper looks to the future, the establishment of a National Breastfeeding Committee, and implementation of the Baby Friendly Initiative into the community.

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  • Post-Operative Pain Management Knowledge and Attitude of Paediatric Nurses: a New Zealand Regional View

    Smart, Sue (2005)

    Masters thesis
    Victoria University of Wellington

    Pain and fear of pain are major concerns for many hospitalised patients. Nurses need to understand this pain, and be able to assess and manage it effectively. Despite advances in knowledge and an increased amount of nursing research related to pain management, literature continues to identify that infants, children and adolescents continue to experience unrelieved pain post surgery. Contemporary literature suggests that nurses’ knowledge and attitudes towards pain affects their pain management practices. Nurses in small regional hospitals often don’t have the support of paediatric pain specialists and therefore rely on their own knowledge, education and experience to manage the pain of the infants, children and adolescents in their care. This research explored the knowledge and attitudes towards paediatric post-operative pain, within the New Zealand context of small regional hospitals. It established how nurses working in these areas obtain and update their paediatric pain management knowledge, and what is it that influences their paediatric post-operative pain management practices. A questionnaire survey of registered nurses working in three small paediatric units (5 to 12 beds), in regional secondary service hospitals was undertaken. The questionnaire developed was based on the Paediatric Nurses Knowledge and Attitude Survey (PNKAS). The survey had a 79% (n=33) response rate. Findings corroborate many findings in previously published literature including that nurses do well in questions related to assessment. However pharmacological knowledge continues to be lacking. Results also indicated that while nurses have a good understanding about who is the best person to rate pain, this wasn’t carried through in the clinical scenarios provided. Education is clearly an important factor in improving the knowledge and attitudes needed in clinical practice. While this survey was somewhat limited, both in size and in that a clear correlation between the results and actual clinical practice could not be made, results are significant for the areas surveyed and for the development of pain education for nurses. Wider research into both pain education and clinical practice is needed. - II - Some of the first steps could be to survey the knowledge and attitude of those who instruct in undergraduate programs related to pain, and review what is being provided in the course programs, and then examine what is being offered within the clinical environments. Research, incorporating chart review and utilising open written questions and/or interviews, or group discussions would provide far more information on which to base recommendations for practice.

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  • Empowerment: What can Nurse Leaders Do to Encourage an Empowering Environment for Nurses Working in the Mental Health Area?

    Casey, Heather (2000)

    Masters thesis
    Victoria University of Wellington

    Nurses, as the majority of the mental health workforce have a valuable contribution to make at a policy development level. The 1998 report from the Ministerial Taskforce on Nursing supports this statement but also indicates that there is a general reluctance by nurses to participate in policy development. For nurses to have control over their practice they need to have input into policy development. Nurses having control over their practice has been linked to nursing empowerment. Therefore the question explored in this research project is: What can nurse leaders do to encourage an empowering environment for nurses working in the mental health area? The literature reviewed for this project includes empowerment, power, the history of nursing in relation to women's role in society, oppression and resistance, and literature on Critical Social Theory as the underlying theoretical and philosophical position which informs the research process. In order to answer the research question a single focus group was used to gather data from a group of registered nurses practising in mental health. Focus groups as a data collection method produce data and insights that would be less accessible without the interaction found in the group. The key themes to emerge from the data analysis were; power is an important component of empowerment and power relationships; and at a systems level, professional, organisational, and political influences impact on feelings of empowerment and/or disempowerment. These key themes are discussed in relation to the literature and the broader social and cultural context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations for nurse leaders who aim to provide an empowering environment for nurses practising in mental health.

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  • Dignity and Palliative Care: a Search to Discover the True Meaning of the Concept of ‘Dying with Dignity’

    Cavanagh, Christine (2004)

    Scholarly text
    Victoria University of Wellington

    This paper presents an exploration of a foundational goal of palliative care nursing which is to help patients die with dignity. The paper presents this practice exploration as a journey to gain understanding of the concept of dignity; it does not avoid the difficulties encountered in practice situations because dying with dignity is unique and curiously also invisible and different for everyone. Much of human life is conducted through stories and much of nursing involves telling and listening to stories. Many of our social institutions are compromised almost entirely of opportunities for telling and retelling stories. Nurses are constantly listening to patients telling them what is going on in their lives and because of this the stories related here are written bold and raw. The three stories explore and reveal in-depth details of nursing practice that evolved and changed after reflection. The paper also reveals and explores the untold and often painful stories that challenge nurses’ capacity to offer dignified care. To deepen the exploration towards discovering ways to articulate the complexity of dignity, the author reflected on the nature of the practice changes documented in the stories and then used a range of diverse literature and her love of the paintings and philosophy of a New Zealander, Ralph Hotere, to support her ideas that dignity is indeed a complex phenomenon.

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  • The Jewel in the Crown: a Case Study of the New Zealand College of Midwives Standards Review Process in Wellington

    Skinner, Joan (1998)

    Masters thesis
    Victoria University of Wellington

    In 1990 New Zealand midwives regained the legal right to practice autonomously Large numbers of midwives exited the hospital system to provide continuity of care both in the community and in the hospital. These midwives practise independently and are funded by the state to do so. The New Zealand College of Midwives has developed and promoted a midwifery model of partnership, incorporating this model into its Code of Ethics and Standards for Practice. In its commitment both to professional development and to accountability, and in partnership with consumers of maternity care, the College developed the Midwifery Standards Review Process. This process involves the midwife in an annual review of her practice. The midwife gathers and collates her statistics, and measures her practice against the NZCOM Standards for Practice. Consumer feedback forms are sent directly to the review co-ordinator. All this information is presented to a panel consisting of two midwifery peers and two consumer representatives. Together with the midwife they discuss her year's work and develop goals for the coming year. The purpose of the review is to provide the midwife with a supportive, educative environment in which to reflect on her practice while at the same time providing an avenue for professional accountability. This study describes the Midwives Standards Review Process in detail using a case study approach. It finds that the process is a unique and innovative addition to the ways peer review and reflective practice can be provided. It identifies the issues of quality assurance, reflective practice, supervision and competence as being of most relevance. In particular it develops the ideas of how reflective practice can be enhanced within a quality assurance model. It recommends that further research is undertaken to ascertain whether midwives using the process find it useful, in particular how it has assisted them in their professional development. Further research may also increase the body of knowledge on the nature of reflective practice and how it is best facilitated.

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  • "It's Beyond Water": Stories of Women’s Experience of Using Water for Labour and Birth

    Maude, Robyn (2003)

    Masters thesis
    Victoria University of Wellington

    This study looks at stories of women’s experience of using water for labour and birth and has explored them to reveal the meaning women make of the experience. Randomised controlled trials report that there are no statistically significant differences in the outcomes for women who use water when compared to those who do not. It has also established that there are no adverse effects on the mother and baby. However, most of the research to date largely ignores what women have to say about the use of water for labour and birth. This study employed an interpretive design using audio-taped conversations with women as the method of data collection, and a thematic analysis of the stories, to identify the meaning women make of their experiences. The research is informed by a feminist perspective, which honours the women’s voices and knowledge. The women's stories reveal that the all-encompassing warmth associated with being enveloped in warm water cradles, supports, relaxes, comforts, soothes, shelters and protects the woman, creates a barrier and offers her a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opens possibilities for women. Women use water to reduce their fear of pain and of childbirth itself. Women use water to cope with pain, not necessarily to remove or diminish pain and to maintain control over the process of birth. It is not necessary to actually give birth in the water to achieve these benefits. Recommendations for midwifery practice include the need for midwives to reflect on their role as guardians of normal birth by examining their personal philosophy of birth, critically examining their outcomes and honouring women's knowledge.

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  • Leaving Your Dignity at the Door: Maternity in Wellington 1950 - 1970

    Stojanovic, Jane Ellen Esther (2002)

    Masters thesis
    Victoria University of Wellington

    This thesis describes the maternity system in Wellington between 1950 and 1970 particularly from the perspectives of consumers and midwives. Four women consumers who experienced maternity in Wellington and two midwives who worked in Wellington’s maternity hospitals during this period provided their oral testimonies as the main primary sources for this study. The author’s recollections of being a student nurse and a consumer in Wellington and other primary and secondary sources are used to substantiate, explore and explain the topic. The study traces the sociopolitical changes in New Zealand maternity from 1900 to 1970 creating a backdrop against which Wellington’s maternity system, including the women, the hospitals, the workforce, maternity practices and the childbearing process are illuminated using the insights of women and midwives who experienced them. “That’s what this lady who had had her baby, said to me, she said, You lose your dignity when you have your baby”, was a comment from one of the interviewed women. This took me back to student days when a common saying was ‘You leave your dignity at the door when you go in to have a baby’. These comments suggested the title for this thesis. The oral testimonies of the six participants described positive and negative aspects of their maternity experiences, but the three strong themes that arose from their accounts included ‘being alone’, ‘lack of autonomy’ and ‘uncaring attitudes’.

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  • Disaster Mental Health Nursing: Implications for Disaster Preparedness and Practice in New Zealand

    O'Sullivan, Helen (1997)

    Masters thesis
    Victoria University of Wellington

    Disaster mental health care is now a recognised nursing specialty in many countries, including Australia, Sweden and the United States of America (Raphael & Meldrum 1993). Despite compelling international literature on the benefits of disaster mental health response, (Myers 1993, Speier 1995),New Zealand has not followed these trends recognising the importance of such health care. Disaster mental health care is conspicuously absent in any meaningful form within our current health system. The majority of Crown Health Enterprise (CHEs), including Capital Coast Health Ltd and Midcentral Health Ltd preparedness plans imply only that mental health services will respond. Unfortunately, the plans say little of how these services are to be met or what is required in terms of knowledge, skills and resources to meet these objectives. The focus of disaster management in New Zealand is trauma orientated, directed towards the surgical, physical and medical needs of casualties. In his experience (Burkle, 1996) argues that triage and disaster management plans, for the most part, fail 3 to include in their classifications the primary casualty who also suffers acute psychological consequences of the physical trauma. New Zealand has experienced many memorable disasters that would seem to have been forgotten in the planning of health care, especially in relation to mental health care needs, both at the national and local service level of planning. The aim of this literature review is to inform the reader regarding knowledge of disaster health care issues such as understanding the impact, public health effects,clinical implications, interventions and the issues, problems and challenges that nurses in New Zealand can learn about mental health disaster preparedness and response. The ultimate goal of this review is to contribute towards the development and implementation of national health care standards and guidelines, focusing on the mental health aspects of disaster care in New Zealand. The framework chosen for this literature review is a combination of epidemiologic public health and service issues, rather than focusing on a singular nursing framework. This is intentional because in New Zealand, mental health nursing is hugely undeveloped or in the main, absent in this area. The frameworks used are expected to inform nursing in the professional provision of disaster mental health care. The rationale for the combination of frameworks used is that disasters affect a community in numerous ways and are considered a public health problem (WHO 1980). Noji (1991) points out that surveys have shown that each kind of disaster has its own common epidemiologic profile and pathologic characteristics. This is crucial in planning and in designing and implementing prevention activities. Within an epidemiologic framework, follow-up studies can assist in identifying risk factors for nurses that would serve as the basis for planning strategies in preventing or reducing impact related morbidity in future disasters. Practical applied and operational research can be useful for nurses in planning public health responses to future disasters. Within this framework it also provides nurses with information useful for client care and developing appropriate mental health relief response.Ideally, the disaster mental health team should be inter-disciplinary and multi-skilled - professionals. Disaster mental health nursing within inter-disciplinary teams is now a well recognised, but still developing specialty in overseas literature, (Myers 1993; Raphael & Meldrum 1993). This literature review supports an interdisciplinary approach as the preferred way of how nursing would fit within disaster mental health care. It is envisaged that the resulting discussion and recommendations form the background for further clinical research and/or background towards formulating health care policies and standards in regards to all aspects of service and professional provision of disaster mental health care in New Zealand, including nursing. It is imperative that both readers and health policy plamers alike are challenged into assisting with frameworks in the areas of preparedness planning, recruitment, training and other local and national relief efforts of various professional groups and disaster service organisations. There is an expectation that all services will respond in a disaster, including mental health. The current reality is that when the next disaster does strike, the public of New Zealand could be failed.

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  • Nephrology Nursing: Early Intervention in Chronic Kidney Disease

    McLaughlin, Kay (2004)

    Masters thesis
    Victoria University of Wellington

    The early diagnosis of a patient with chronic kidney failure presents enormous opportunities for the nephrology health care team. Current research has identified that appropriate and timely education and management during the early stages of kidney disease reduces health care risk to the patient and lowers associated cost. This study explored the potential for extending the contribution nurses make in managing patients with chronic kidney disease as they progress to end stage kidney failure. In the context of a shortage of nephrologists and an escalating patient population suffering from kidney disease, the potential to include advanced nephrology nursing in early disease management was postulated. The literature was reviewed with regard to initiatives to reduce the progression of kidney failure and the prevention of associated complications. Local and international literature on advanced nursing practice and the nurse practitioner role was examined in relation to the management of chronic kidney disease. The introduction of the nurse practitioner in New Zealand could provide an ideal framework for independent nephrology nursing. Well-established nursing practice in dialysis, transplantation and pre-dialysis provide distinct scopes of practice in these areas for independent nursing in the future. It seems likely that these sub-specialties in nephrology nursing will be the first to experience the value of the nurse practitioner. The creation of early interventionalist nurse practitioners in nephrology health care would allow nurses to step outside these well-established sub-specialties, and provide new resources to help manage chronic kidney disease. A model of care was proposed that outlines how a nephrology nurse practitioner could work collaboratively with community health providers and the local nephrology health care team to manage the early stages of kidney disease. It is evident that early intervention and ongoing management of patients with chronic kidney disease is currently suboptimal. The development of the nephrology nurse practitioner is an innovative way to reach the nephrology community and meet health needs in a cost-effective manner.

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  • Reading Between the Lines: Representations and Constructions of Youth and Crime in Aotearoa/New Zealand

    Beals, Fiona M (2006)

    Doctoral thesis
    Victoria University of Wellington

    In this thesis, I examine constructions of youth deviance in Aotearoa/New Zealand, 2002. In 2002, New Zealand had a national election in which adult commentators and observers concentrated and speculated on the reasons for a supposed increase in youth deviance and a spate of extraordinarily violent youth crimes. Youth-at-risk, early intervention, the family, and education were words that emerged continuously in commentator discussions. There was no critique of these words, or the practices they implied, and very little discussion of the implications the use of these words and practices posed for young people. In this thesis, I address this gap in the discussion by critically exploring the ways in which authors in institutional contexts constructed deviant youth and the implications of these constructions for youth. In this research, I sampled published texts in 2002 from academia, government, and media; three institutions which produce and reproduce knowledge in New Zealand. I applied a form of discourse analysis to the texts to explore and contextualise evident constructions. This analysis involved a bricolage of poststructural methodologies in the attempt to make an accessible argument, which effectively addressed the purposes of the research. I found that authors did not apply a knowledge devoid of power. Whether used to construct a picture of the deviant youth, or to describe necessary interventions into deviance, they used knowledge to construct the deviant youth as powerless effects of development and risk. Authors used knowledge to divide young people into the abnormally-deviant youth-at-risk and the normally-deviant adolescent. Applying knowledge allowed those writing about youth crime to construct and position young people as powerless. Authors reinforced this when they used knowledge to inform practices and interventions, which allowed adults to control the young person’s access to, and use of, power. In particular, authors and other experts saw mass education as a powerful practice of control and socialisation. Through education, adult society could remove the abnormallydeviant youth from the dysfunctional family environment and re-socialise the young person into conformity. Those writing applied a similar reasoning in other described interventions such as surveillance, conferencing, and early intervention. Interventions allowed adults to control the deviance of youth. I finish this thesis by arguing that interventions and contradictions in constructions show that power is not one-sided. That is, power is not always in the hands of adults. Rather, sociological theory can be applied to demonstrate and explore a power struggle between adults and young people where resistance coexists with power. I argue that resistance can provide an alternative explanation to the dominant ideas held by those working with, and talking about, deviant youth. Resistance allows for a concept of agency in which both deviance and non-deviance can be seen as a reactive response by the young person.

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  • Distributed Small-Scale Wind in New Zealand: Advantages, Barriers and Policy Support Instruments

    Barry, Martin (2007)

    Masters thesis
    Victoria University of Wellington

    Despite having one of the best wind resources in the world, New Zealand’s wind energy industry is growing at a slower rate than the OECD average. This is arguably due to a lack of appropriate government support, with industry development largely being left to the market. These conditions have created a wind industry with the following four characteristics: a trend toward large-scale wind farms (leading to increased local opposition), a small number of investors, a high geographic concentration of wind capacity and a limited local turbine manufacturing industry. These characteristics are arguably limiting the potential growth of New Zealand’s wind industry. This thesis investigates whether small-scale wind (SSW) farms can alleviate these limiting characteristics and thus provide for a higher rate of industry growth. The approach is to investigate the advantages of, barriers to, and most effective policy instruments for SSW internationally, and apply these to the New Zealand context. Local research was conducted through interviews with 19 energy industry stakeholders and a rural mail survey questionnaire, to which 338 people responded. Research found that SSW offers a number of advantages: significantly higher local public acceptance; facilitation of community ownership; the potential for distributed generation benefits and support for the local turbine manufacturing industry. Given these findings, it is argued that SSW can provide for a higher rate of industry growth in New Zealand. The key barriers constraining SSW in New Zealand are its high cost, obtaining resource consent, a high degree of perceived investment risk, the electricity pricing system and the electricity market structure. The feed-in tariff appears to be the best policy instrument to overcome these barriers, along with the provision of investment subsidies and the classification of SSW as a controlled activity under the Resource Management Act 1991 (RMA).

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  • Nurses as Patients: the Stories of Two Woman Nurse Educators as Recipients of Nursing Care

    Harker, Dianne Yvonne (2000)

    Masters thesis
    Victoria University of Wellington

    In this research two nurse-patients have engaged in a conversation about their experience of ‘being nursed’. The project sets out to address the following questions: How might our experiences as nurses who have been hospitalised be drawn upon to influence positive changes in nursing practice? What effect might our experiences of hospitalisation have on us as nurses and on our nursing practice? The study utilises narrative as inquiry and the method of story telling and auto/biography to tell the stories of Maria (a pseudonym) and myself, the researcher. This interpretive research has been informed by the feminist process and sits within a postmodern framework. Maria’s stories were audio taped and transcribed before being prepared for analysis using ‘core story creation’, and the process of 'emplotment' (Emden, 1998b). My reflective topical autobiographical narrative was constructed through the processes described by Johnstone (1999). Three distinct qualities emerged from both of our experiences. The first, ‘knowing as nurse-patient’ contains the three sub themes of ‘having knowledge’, ‘expectations of being nursed’, and ‘knowledge gained’. The second distinct quality ‘being nursed’ contains the two sub themes of ‘feeling safe and cared for’ and ‘presencing’; and the third ‘not being nursed’ contains the four sub themes ‘feeling vulnerable’, ‘invisibility of nurses’, ‘getting out’ and ‘feeling let down’. The sub theme ‘getting out’ includes three additional sub themes of ‘wanting to get out and not wanting to be there’, ‘leaving and the need for closure’ and ‘not wanting to go back’, This study on nurse-patients receiving nursing care will be useful for nurse educators, students of nursing, and nurse clinicians. Nursing does make a difference to patient care. For patients to receive therapeutic care new graduate nurses must be preceptored/mentored by experienced nurses in supportive programmes. Suggestions for further research have been identified.

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  • Critical Case Study: Supporting the New Graduate Nurse Entering Specialist Psychiatric Mental Health Nursing Practice

    Haggarty, Carmel Elizabeth Anne (2000)

    Masters thesis
    Victoria University of Wellington

    This critical case study was undertaken for the purposes of illuminating information relating to new graduate nurses’ experiences in their first clinical placement, in order to consider ways an established entry to practice programme (the programme) can better support and enhance the students’ transition from student nurse to staff nurse within psychiatric mental health nursing practice. Seven of the 1999 students of the programme participated in the research. The project provided the researcher with a variety of challenges related to her dual role as researcher and programme coordinator. Data was collected through the use of discussion groups, participants and researcher jointly identifying the themes that were explored. These themes related to preceptorship and support, socialisation of the new graduate and risk management. The research has provided rich data that has and will continue to be used to inform future developments within both the educational and clinical components of the programme. The research has also provided opportunities for personal and professional growth through the sharing of experiences and working together to identify emancipatory action which has in turn led to transformation.

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  • Why do Nurse Graduates Choose to Work in the Area of Mental Health?

    Kempthorne, Anna (2006)

    Masters thesis
    Victoria University of Wellington

    The low numbers of nurses attracted to work in mental health is a concern particularly with the increased demand for mental health services. Strategies are required to increase recruitment to this less popular area of nursing to ensure that a high quality of care is provided for people suffering from mental illness. The World Health Organisation (2004) is aware that this area of health has been neglected and that it is time to promote mental health. This study aimed to examine the influences involved in nurses choosing to work in this area. A descriptive survey using a questionnaire was given to seven groups of new graduates enrolled in the New Graduate Mental Health Nursing programme through five educational institutes within New Zealand. At the time of writing there were no published studies around this topic in New Zealand. This study will attempt to inform nurses, the Nursing Council of New Zealand, tertiary institutions and the government of New Zealand that there is evidence that we need to develop and change practices to address the predicted workforce decline.

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  • Reliability Study of the Sedation-Agitation Scale in an Intensive Care Unit

    Ryder-Lewis, Michelle (2004)

    Masters thesis
    Victoria University of Wellington

    The management of sedation in critically ill patients is a complex issue for Intensive Care Units (ICU) worldwide. Notable complications of sedation practices have been identified and efforts to modify these practices in ICUs have begun. While sedation-scoring tools have been introduced into clinical practice in intensive care few have been tested for validity and reliability. One tool which has reliability and validity established is the Sedation-Agitation Scale (SAS). This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the SAS in a natural ICU setting. It is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience. The implementation of the SAS should improve the quality of sedation management in critically ill patients, facilitate communication between nurses and medical staff with regard to the effectiveness of sedation regimes, and assist with the development of optimal sedation and analgesia guidelines for ICU patients.

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  • Colonisation: the Experience of a Psychiatric Nurse Through the Lens of Reflective Autobiography

    Ramsamy, Krishnasamy (2006)

    Masters thesis
    Victoria University of Wellington

    The oppression of colonization lives on in the daily lives of colonized people. It is vital for us as nurses to understand the effects of that oppression, as well as the restrictive impacts, and dislocation from one's land and culture to-day. Nurses come from both the descendants of colonisers and the colonised. This thesis is a journey and a quest for insights into the impacts and significances of colonisation by looking at historical and socio-political contexts that have bearing on the health of colonised people who remain mostly powerless and marginalized. It is prompted in response to a cultural safety model which advocates that nurses should become familiar with their own background and history in order to be culturally safe in practice. This reflective autobiographical account is a personal effort and provides the foundation for an exploration of issues during nursing practice encounters, from a colonised ethnic minority perspective. The method was informed by Moustakas research approach and Johnstone's Reflective Topical Autobiographical process. The selection of specific events are deliberate, to make visible some of the many barriers that exist within our health structures as pertinent issues for non-dominant cultures that remain on the margin of our society. Maori issues provide a contrast and became a catalyst for me as the author while working for kaupapa Maori services in Aotearoa/New Zealand. The intention of this thesis is to generate new knowledge about what it means to be a nurse from an ethnic minority working in a kaupapa Maori mental health service, and to encourage other nurses to explore these issues further. Some recommendations are made for nurses in the last chapter, as I believe that they are ideally situated to build upon the strengths indigenous people already have and contribute positively toward the improvement of poor health outcomes of the colonized people in an embracing and collective way.

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  • Disquiet in the Development of Clinical Supervision for Professional Development in Nursing Practice: a Literature Review

    Robertson, Gaye (2000)

    Scholarly text
    Victoria University of Wellington

    Nursing literature reflects that nurses have been exploring and experiencing the process of clinical supervision for well over a decade. Nurses in the United States (U.S.), United Kingdom (U.K.), Scandinavia, and Australasia have written much over the past fifteen years. While nurses grapple with what clinical supervision is within nursing development and disquiet continues to emerge in the literature. While the process of clinical supervision has been borrowed from the fields of psychotherapy, social work, counselling and mental health nursing, resulting in different forms of implementation, a considerable body of data has been developed illustrating nurses' experience of developing the process within their own varied areas of practice. This literature review will expand on themes that surround this disquiet. These centre on continued confusion and lack of clear definition; whether psychotherapy is implemented under the guise of clinical supervision, who uses it, and the dearth of empirical evaluation of its effectiveness. The lack of significant empirical evidence of its ability to assist practitioners to deliver improved patient/client care continues despite claims of improved professional and personal development, therapeutic relationship, and occupational stress management. These claims come from both supervisees and supervisors. The manner in which clinical supervision is portrayed in nursing in that it is frequently referred to as a support system, rather than one of learning a complex set of communication skills is also highlighted. The continued debate on what model(s) best suit nurses, or whether line management should provide clinical supervision as a means to ensure quality standards and control over nursing practice and optimal patient care is discussed. Whether nursing should stop borrowing from other fields and develop their own model(s) is also a question being raised. Two emerging stances focus on a process that is practice-based as identified by senior staff and management, or one that continues along the lines of what psychotherapy has developed with practitioner-identified developmental needs. These issues raise many questions for further development in nursing, one being are nurses developed enough in their self-awareness to understand what they are to adopt into their practice? Authentic voices from those nurses experienced in the practice of providing and receiving clinical supervision, are shaping therapeutic practice for nurses in the future, and continue to sharpen the debate. Some reference to unpublished data and local practice in the Wellington area, New Zealand, have been included as a stimulus for further incorporation of clinical supervision in local practice development.

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  • Hearing the Adolescents' Voice: a Study Evaluating the Use of Conjoint Analysis for Use with Adolescents to Determine Preferences for Inpatient Hospital Facilities

    Gibson, Catherine (2005)

    Masters thesis
    Victoria University of Wellington

    Some adolescents spend considerable time in hospital in environments that are designed either with adults or with younger children in mind. This research used the economic technique of conjoint analysis and an informal discussion to canvas opinions regarding ideal combination of inpatient facilities and, because of the changing youth culture, the use of cell phones in hospital. The content of the conjoint analysis was, with the exception of the inclusion of the question regarding the use of cell phones, derived from the literature. Because conjoint analysis does not appear to have been used with adolescents one of the questions to be answered was whether this was a method of research that could be used with adolescents. The research was undertaken with 29 young people, most of who were from CanTeen (the adolescent cancer support group) in Wellington. The conjoint analysis, and discussion with the adolescents supported the general findings from the literature that adolescents do not want to be nursed in either overtly paediatric or, in their words, ‘dull adult wards’, as they enjoy bright lively surrounds. Ideally they would like to be nursed with their peer group and so have the opportunity to interact with young people of their age. The research demonstrated that adolescents are able to understand the concept of conjoint analysis and also supported findings from overseas that these healthcare consumers value having their opinions canvassed and are well able to give constructive and well thought out opinions. A report on the findings of this research will be presented to Capital and Coast District Health Board with the expectation that it will be considered when the final decisions are made regarding the upgrading of Wellington Hospital’s present facilities as it is anticipated that these facilities will contain dedicated adolescent beds within the paediatric unit.

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  • Developing a Nursing Speciality - Plunket Nursing 1905 - 1920

    Andrews, Christine Mary (2001)

    Scholarly text
    Victoria University of Wellington

    There are many factors that have shaped the development of nursing in New Zealand's history but one stands out more than most. Plunket nursing owes its origins to the mind of one of our country's most famous early medical men, Frederic Truby King. This idealistic zealot set out to improve the welfare of mothers and infants, creating a nursing role as he went. This paper focuses on the history of Plunket nursing and Truby King's ideology and other dominant ideologies, during the years 1905 - 1920. To provide a context for this, the paper explores the development of a new nursing speciality - Plunket nursing, that became part of the backbone of a fledgling health system and the New Zealand nursing profession. Correspondingly, Truby King presented the country with a vision for improving infant welfare underpinned by his eugenics view of the world and his experimentation with infant feeding. Nurses were drawn to the work of the newly created Plunket Society. They were keen to adopt its principles and to preach the gospel of its founder.

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  • Neotectonics and Paleoseismicity of a Major Junction Between Two Strands of the Awatere Fault, South Island, New Zealand

    Mason, Dougal P M (2004)

    Masters thesis
    Victoria University of Wellington

    In northeastern South Island, New Zealand, obliquely-convergent relative motion between the Pacific and Australian plates is accommodated by slip across active dextral-oblique faults in the Marlborough fault system. The Awatere Fault is one of four principal active strike-slip faults within this plate boundary zone, and includes two sections (the eastern and Molesworth sections) that have different strikes and that join across a complex fault junction in the upper Awatere Valley. Detailed mapping of the fault traces and measurement of 97 geomorphic displacements along the Awatere Fault in the vicinity of the fault junction show that the eastern and Molesworth sections of the fault intersect one another at a low angle (10-15º), at the eastern end of an internally faulted, elongate, ~15 km long and up to 3 km wide fault wedge or sliver. The region between the fault sections is split by a series of discontinuous, en-echelon scarps that are oriented from ~10º to 20-30º clockwise from the principal fault sections. Based on other observations of discontinuities in strike-slip earthquake ruptures around the globe, this low-angle intersection geometry suggests that the junction between these fault sections may not act as a significant barrier to earthquake rupture propagation. This interpretation of the mechanical significance of the fault junction to earthquake ruptures is counter to previous suggestions, but is supported by new paleoseismic data from four paleoseismic trenches excavated on each side of the junction. In a new paleoseismic trench on the Molesworth section at Saxton River, 18 km to the west of the junction, up to ten surface-rupturing events in the past ~15 ka are recognised from 12 radiocarbon ages and 1 optically stimulated luminescence age. In two new trenches on the eastern section near to Upcot Saddle, 12 km northeast of the fault junction, five events took place in the past 5.5 ka, based on 21 radiocarbon ages. This chronology from Upcot Saddle is combined with data from two previous trenches located ~55 km to the northeast at Lake Jasper, to infer nine events on the eastern section since 8330-8610 cal. years B.P. These well-dated events on the eastern section are compared to those on the Molesworth section to the west of the fault junction. At 95% confidence, five events on both sections have occurred with statistical contemporaneity since ~6 ka B.P. These five events may have ruptured both the eastern and Molesworth sections simultaneously, in accordance with the interpretation that the fault section junction does not arrest rupture propagation. Alternatively, these events may have been separate earthquakes that occurred within the statistical resolution provided by radiocarbon dating. The most recent event to rupture the eastern section was the Mw ~7.5 1848 Marlborough earthquake. The coseismic slip distribution and maximum traceable length of this surface rupture are calculated from the magnitude and distribution of small, metre-scale geomorphic displacements attributable to this earthquake. These data suggest this event ruptured >100-110 km of the eastern section, with mean surface displacement of 5.3 ±1.6 m. Based on these parameters, the moment magnitude of this earthquake would be Mw 7.4-7.7. This magnitude estimate is indistinguishable from previous calculations that were based on attenuation of shaking intensity isoseismals that were assigned from contemporary historical accounts of that earthquake. On the basis of similar rupture lengths and coseismic displacements, it is inferred that the penultimate event had a similar moment magnitude to the 1848 earthquake. Horizontal displacement of a flight of 6 fluvial terraces at Saxton River by the Molesworth section of the Awatere Fault is constrained to have occurred at a nearconstant rate of 5.5 ±1.5 mm/a since ~15 ka B.P. These rates are based on two new optically stimulated luminescence ages for the highest terrace treads of 14.5 ±1.5 and 6.69 ±0.74 ka B.P. These rates are indistinguishable from recent strike-slip rate estimates for the eastern section of 5.6 ±1.1 and 6 ±2 mm/a. Comparing the magnitudes and ages of the terrace riser displacements at Saxton River to the timing of paleoearthquakes on the Molesworth section implies a mean per-event displacement of 4.4 ±0.2 m since ~15 ka. The new terrace ages also record two periods of aggradation that post-date the Last Glacial Maximum.

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