Nursing and Midwifery
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/1264
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Item In search of nursing : the long-term impact of the New Zealand health reforms on ward nursing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Manawatu, New Zealand(Massey University, 2012) Teekman, Englebert CornelisThis thesis began with my curiosity about why, despite repeated attention to nurses’ health assessment skills (at undergraduate and professional development level), it has remained an under-utilised skill. A focused ethnography was conducted in six acute wards of a provincial New Zealand hospital. Twelve registered nurses were observed and interviewed in the first phase of the research and multiple additional primary data sources were utilised. Early findings indicated that nurses did not undertake health assessment and raised much broader questions about the nature of ward nursing practice and the amount of control ward nurses have over their work environment and their own nursing practice. The research was extended to include seven stakeholders, senior nurses who had good insight and knowledge of ward nursing practice. A structuration theory lens was applied to assist in the analytic process. The findings of this research reveal the long-term impact of the NZ health reforms on ward nursing practice. The introduction of generic management principles and the continuous restructuring of the health care environment have impacted on nursing practice and reduced nurses’ autonomy. Nurses have come to rely on standardised documented processes to provide essential care, relying significantly less on knowledge of a patient’s actual health status. Much recent local and international quantitative research has revealed a number of concerning findings about the reduced time nurses spend at the bedside, the complexity of nursing work flow, the increase in interruptions, missed nursing care, and the vital role nurses have in preventing many adverse events and unexpected deaths. This thesis provides a rich qualitative understanding of the circumstances behind these quantitative findings and reveals that nurses are now struggling to provide care consistent with the ethos of nursing. I argue that challenging the nature of nurse education will not improve nurses’ ability to deliver nursing care. Instead I argue that the current acute ward environment does not support registered nurses to provide the nature of care for which their education has prepared them.Item Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand(Massey University, 2011) Russell, NicolaThe ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.Item Implementing a Critical Care Outreach Team : what difference has it made for nurses? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand(Massey University, 2011) Davies, Kathryn ErinThe aim of this study is to describe the implementation of Critical Care Outreach (CCO) and to understand what difference implementing a Critical Care Outreach Team (CCOT) has made to ward nurses in a secondary level general hospital in New Zealand. A CCOT was established at the study hospital in 2006. The aim was to implement an early warning score, to provide education and to share appropriate intensive care skills from CCOT nurses on the wards. Additionally, patients discharged from the Intensive Care Unit were to be followed up. The difference this made to ward nurses in this hospital was unclear. International studies had reported suboptimal patient care on acute wards and the emergence of CCOTs. Research was warranted to gain an understanding of the impact of the service on ward nurses. The methodology chosen for the study was case study, and was underpinned by Change Management Theory and elements of whole system reform (Fullan, 2010). Fullan’s (2007) Change Management Theory of a three phased approach to change management, initiation, implementation and institutionalisation was selected for the study. Data was collected from a nursing focus group, three interviews, and District Health Board documents related to the CCOT. Interviews and nursing focus group data were analysed by thematic analysis and documents analysed by subject. Implementing the CCOT facilitated the shift of late recognition/late intervention of patients to early recognition/early intervention. An area of whole hospital reform occurred. The use of an early warning score promoted more timely patient review, communication between nurses and doctors, improved observation frequency and an environment of objectivity developed. Nurses benefited from education, were empowered to escalate patient concerns, improved their assessment and specific clinical skills, and reported that they were supported by the CCOT. The CCOT has had a positive effect on the early recognition and early intervention of the physiologically unstable patient. The challenge to New Zealand nursing now is to continue to build on the evidence from this study that CCOT has a beneficial impact on ward nurses. The challenge to the District Health Board is to preserve CCOT to ensure that nurses are supported and late recognition/late intervention is truly a phenomenon of the past.
