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    Patients who present to the Emergency department but do not wait : an exploratory study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 2004) Baur, Peter
    People who do not require urgent treatment often visit Emergency Departments. Furthermore, a small - yet significant - group leave the Emergency Department (ED) before even being seen by a doctor. Previous studies suggest that most people who do not wait (DNW) having presented to the ED and then leave without being seen by a doctor may have non-urgent conditions. However, other studies contradict this. This is an exploratory study into this subject. Its main aims are to: □ correctly define this DNW group who present to EDs; □ identify the size of a DNW population in a New Zealand setting; □ establish common factors that influence people's decision to present then leave and; □ ascertain whether nursing practice may impact on this population of emergency presentations. Data collection took place, over a period of 4 months, in a Level 5 District Health Board Emergency Department in New Zealand. The study uses a retrospective cross-sectional postal survey design to secure data on people's experiences of the ED, asking them, amongst other things, why they did not wait. The study sample consisted of 642 people. 489 people were sent postal surveys which resulted in a response rate of 18% (n = 92). Data was analysed and compared using a combination of quantitative and qualitative techniques, using SPSS© and MS Excel© statistics software, elements of operations research (field observation) and content analysis. Subjective data was illuminated and extended by qualitative methods, namely interpretative and descriptive content analysis and an abstract conceptualisation of the themes generated is offered. Regional Ethics Committee approval was sought and granted prior to this investigation commencing. The results indicate that the majority of DNWs occur during daylight hours. The mean age of those who DNW was 27 years. They tended to be male. The greatest proportion of the DNW population analysed lived locally and waited a mean time of 112 minutes before choosing to leave. All Australasian Triage Scale categories (except ATS 1) demonstrated examples of those who took a DNW discharge. The most common complaints people presented with were ones they had endured for more than 12 hours and were sometimes days old. A high proportion of people reported that they received definitive treatment within 12 -24 hours following their departure from the ED. Common themes identified as reasons people chose to leave the ED related to their perception of action, perception of their illness and environment. Additional themes extracted from the data that influenced people's decisions to leave concerned their perceptions of staff communication/behaviour; systems processes; feelings of abandonment; other commitments and waiting time.
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    Lived experiences of nurses as they engage in practice at an advanced level within emergency departments in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Human Social Science (Nursing) at Massey University
    (Massey University, 2005) Davies, Mark
    At this present time New Zealand has seventeen Nurse Practitioners™ none of whom work in the emergency setting; nonetheless emergency nurses throughout New Zealand are practising at an advanced level in departments nationwide. The aim of this research project was to examine the lived experiences of five nurses as they prepare for, and engage in practice at an advanced level within emergency departments in New Zealand. The theoretical framework for this project was one of phenomenological enquiry based on a synthesis of Husserlian and Heideggerian philosophy. Following a form of purposive sampling to select participants, unstructured in-depth interviews were used as the method of choice for data collection. The concept of data horizontalisation integrated within Colaizzi's (1979) procedural steps for data examination guided the analysis and findings of this work. Descriptions of the participants lived experiences, underpinned by Husserlian principals, identified eight subjects that were explored in-depth from their perspective. This was followed by further analysis, interpretation and discussion of the phenomenon under review from the researcher's perspective; guided by the fundamental elements of the Heideggerian approach to enquiry. The results show that there are numerous similarities to be had in common with our colleagues overseas in relation to the many issues that impact on nurses working in or toward advanced practice within emergency departments here in New Zealand. However there also exist issues that are unique to the New Zealand context and as such have the potential to impact either positively of negatively on the development of the advanced nursing role in this country, such as the Health Practitioners Competency Assurance (HPCA) Act 2003 and other legislation that relate either directly or indirectly to the scope of practice for advanced practitioners, whatever their area of expertise. The research process identified several concepts that require further debate and discussion; from which knowledge can be gained that will either add to or augment the body of knowledge that is required for the advancement of nursing practice within emergency departments here in New Zealand.